Chapter Twelve

Chapter 12:
Using the MMPI-A Content Scales
- developed using the multi-stage, multi-step scale-development procedures described in Chapter 6
- for the first time, the content scales were constructed using adolescent samples, as well as using rational procedures that ensured consideration of the unique developmental features of this age range
- item content new to the MMPI-A and specifically related to adolescence was used

Development of the MMPI-A Content Scales
- Stage 1: examination of the appropriateness of the MMPI-2 content scales for adolescents (rational analysis)
o determine if any of the MMPI-2 constructs seemed developmentally inappropriate for adolescents
§ Work Interference scale seemed irrelevant, many school-related items take its place
o Removed any other items that seemed developmentally inappropriate
o Added adolescent-specific items, & had raters identify a list of potential adolescent-specific content scales (Adolescent-School Problems, Adolescent-Alienation, Adolescent-Low Aspirations)
o Eliminated item overlap by developing separate scales assessing acting-out problems: Adolescent-Conduct Problems, Adolescent-School Problems, Adolescent-Family Problems, Adolescent-Alienation
- Stage 2: Statistical verification of the provisional content scales
o Carried out item/scale correlations (do the items that were rationally selected actually belong on these scales?)
o Both the MMPI-2 Type A & Adolescent-Low Aspirations scales had reliability coefficients in the (.55 - .65) range
o Type A scale was dropped from MMPI-A because of low reliability and low validity
- Stage 3: Final rational review of the provisional scales
o developed an alternative Antisocial Practices scale
o Adolescent-Conduct Problems scale developed because of the poor validity for Antisocial Practices scale in adolescent samples
- Stage 4: Final statistical refinement
o Items that were more highly correlated with other scales were eliminated from the provisional scales
o Final reliability & validity coefficients calculated, as were uniform T scores
o 9 of the scales had strong validity, and several others had adequate validity. Additional validity work is needed for A-cyn and A-trt scales.
- Stage 5: (rational) Writing descriptions of the scales
o Descriptions, and validity coefficients (from stage 4) were the basis of the descriptors presented in the next section
o One MMPI-2 Content Scale (Fears) was dropped from MMPI-A because it had 13 items that were unique to it, by dropping it, the MMPI-A was shortened, and there were other anxiety-related measures on the MMPI-A


Comparison of the MMPI-A and MMPI-2 Content Scales
- developed using similar procedures and theoretical perspectives
- different age-appropriate samples
- some scales differ by very few items (e.g. Anx , Hea, Cyn)
- some scales have very little overlapping content (e.g. Fam)
- One changed substantially (ASP became A-con)
- Three content scales unique to MMPI-A due to developmentally inappropriate content for adults: A-las (low aspirations), A-sch (school probs), A-aln (alienation)
- Three content scales not included in MMPI-A: FRS (fears), WRK (work interference), TPA (Type A)

Interpretation of the MMPI-A Content Scales
- 2 sources for interpretive statements: item content & empirically derived descriptors or correlates
- Item Content:
o elevated T scores (60-64 = moderate) (65 or more = high) means that a person has endorsed more of a particular group of symptoms than the normative group
o Average & low scores indicate that the person does not say that the scale’s content is descriptive of him/herself (either accurately, or because of an unawareness or unwillingness to admit the problems)
- Empirically derived descriptors
o Correlations between the content scales and external data (e.g. parent/staff ratings, record reviews)
o Empirically based descriptors from other samples (psychiatric inpatients, incarcerated delinquent boys)

Adolescent Anxiety
Content-based interpretive statements
- report symptoms of anxiety, tension, worrying, nervousness, difficulties sleeping
- report problems with concentration, confusion, inability to stay on task
- life is a strain, many difficulties, high stress
- worry about losing their mind, something dreadful will happen
- appear aware of problems and how they are different from others
Empirically based interpretive statements
- empirical validity supported in a combined gender sample of psychiatric inpatients & sample of incarcerated delinquent boys
- report anxiety, physiological symptoms, low energy, depressive symptoms, somatic complaints, social withdrawal/introversion, but not externalizing symptoms
- (delinquent boys) also suicidal ideation, concentration difficulties, restlessness, agitation, self pity, fears of dying/losing control, obsessions & compulsions
- likely to be experiencing family discord
- (girls in clinical settings) likely depressed & somatic complaints

Adolescent Obsessiveness
Content-based interpretive statements
- report worrying excessively, difficulty making decisions, dread making life changes, often regretful, may ruminate about “bad words”, may count unimportant items
Empirically based interpretive statements
- (girls) likely to have increasing disagreements with parents
- (girls in clinical settings) suicidal thoughts, but not attempts
- (delinquent boys) greater lethality of suicidal acts
- (clinical boys) overly dependent, clinging to adults, anxious, overly concerned about future, resentful, obsessed, worried, preoccupied with feelings of being bad/deserving punishment
- (delinquent boys) agitated & restless, but with slowed speech and psychomotor retardation at other times

Adolescent Depression
Content-based interpretive statements
- frequent crying spells, fatigue, self-deprecative thoughts, beliefs that they have not lived the right kind of life/they are condemned/their sins are unpardonable
- report feeling blue, wishing they were dead, think of killing self, loneliness, feeling useless, future seems uncertain, unable to “get going”
- some seen as much happier
- sense of hopelessness, not caring what happens, inclination to take things hard, dissatisfied with life
Empirically based interpretive statements
- (psychiatric inpatients) feelings of depression, low energy, somatic complaints, anxiety, social withdrawal
- (delinquent boys) depression, irritability, excessive guilt, fatigue, restlessness, agitation, concentration difficulties, psychomotor retardation, insomnia, anorexia, self-pity, fears of dying/losing control, panic symptoms, need for reassurance, chronic rule violations, high potential for suicide (multiple/lethal methods)
- (clinical girls) low self esteem, depression
- (girls in normative settings) less likely to have good grades, or to be recognized for personal achievement, more likely to be concerned with sig. weight gain

Adolescent Health Concerns
Content-based interpretive statements
- report physical problems interfering with enjoyment of activities, and contributing to school absence; worse physical health than peers
- GI problems, neurological problems, sensory problems, cardiovascular problems, skin problems, pain, respiratory problems
- Worry about health and feel their problems would disappear if health improved
Empirically based interpretive statements
- somatic complaints
- academic & behavioural problems, (poor grades, course failures, suspensions)
- (parents report) nausea/vomiting, pains, headache, dizziness, rash, eye probs.
- (clinical girls) report increasing disagreements with parents
- (clinical boys) seen by parents as worried, anxious, accident- & guilt-prone, clinging, fearful, perfectionist
- (delinquent boys) feel depressed about incident leading to incarceration, resist feelings of irritability, are restless, show cruelty to others

Adolescent Alienation
Content-based interpretive statements
- report emotional distance, feel unliked by others, no-one understands them, others are out to get them, don’t believe they have as much fun as others, would prefer living alone, difficulty self-disclosing, others block their attempts at success
Empirically based interpretive statements
- depression, hopelessness, helplessness
- less likely to have high grades in school
- (girls) weight gain
- (delinquent boys) sleep problems, aches and pains, panic, difficulty concentrating, restlessness, cruelty toward others

Adolescent Bizarre Mentation
Content-based interpretive statements
- strange thoughts and experiences, auditory/visual/olfactory hallucinations
- believe something is wrong with their minds
- paranoid ideations, others trying to steal their thoughts, or control minds
Empirically based interpretive statements
- behaviour and academic problems
- (clinical settings) show bizarre or psychotic behaviours
- (clinical girls) disruptive families (parents/siblings with arrest records)
- (clinical boys) have child-protection workers, strange behaviours & mannerisms
- (delinquent boys) depression assoc. with event leading to their incarceration, concentration difficulties, anorexia, suicidal ideation, blame others, cruel to others, report childhood perceptual phenomena

Adolescent Anger
Content-based interpretive statements
- report anger control problems, break/destroy things, problems with irritability and impatience with others, throw temper tantrums, do not like others to hurry them, hot-headed/have to yell to make a point, get into fights (esp. when drinking)
Empirically based interpretive statements
- act out in school or at home, history of assaultative behaviours, anger control problems, resentfulness, impulsivity, impatience, variable moods, externalizing behaviours
- (clinical boys) may need reassurance, be overly clinging/dependent, attention seeking, self condemning, anxious about future, feel deserving of punishment
- (incarcerated delinquent boys) depression, fatigue, irritability, shouting, complaining, agitation, insomnia, grandiosity, racing thoughts, impulsivity, difficulty playing quietly, blaming others, cruelty
- (clinical girls) likely to have had court appearances, described by parents as aggressive and delinquent, act out sexually/promiscuity, provocative clothing/behaviour

Adolescent Cynicism
Content-based interpretive statements: misanthropic attitudes, believe others are out to get them, use unfair means to gain advantages, look for hidden motives, trust no one, inwardly dislike to help others, feel misunderstood by and jealous of others
Empirically based interpretive statements: (delinquent boys) argumentative, unusually active/energetic
Adolescent Conduct Problems
Content-based interpretive statements
- behavioural problems (stealing, lying, destroying property, being oppositional)
- legal difficulties, try to get around the law, peer group often in trouble, entertained by each others’ criminal behaviour
Empirically based interpretive statements
- acting out behaviours, these problems more readily acknowledged by girls
- (normative girls) self-reported disciplinary problems, suspension, course failures, cheating/lying in school (more likely to admit to these than boys)
- likely to use alcohol & drugs, court involvement
- delinquent behaviours reported by parents, anger control, lying, cheating, unpredictability, volatility, sexually active & provocative (as reported by treatment staff)
- (girls) report family discord,

Adolescent Low Self Esteem
Content-based interpretive statements
- negative opinions of themselves, feel unattractive, lack self confidence, feel useless, yield to pressure from others, let other people take charge, difficulty accepting compliments, confused and forgetful
Empirically based interpretive statements
- (girls) poor grades, significant weight gain
- (clinical boys) poor social skills, possible sexual abuse history
- (clinical girls) depressed, suicidal, learning disabilities, disagreements with parents
- (incarcerated delinquent boys) guilt, self pity, concentration difficulties

Adolescent Low Aspirations
Content-based interpretive statements
- disinterested in being successful (esp. academically), do not like to study or read, prefer work where they can be careless, expectations of success are low, report difficulty starting things, quickly give up when things go wrong, let other people solve problems, believe others block their success
Empirically based interpretive statements
- more likely to have poor grades, less likely to participate in school activities
- (clinical boys) truancy, avoid school, run away from home
- (clinical girls) engage in sexual acting out, less likely to win awards
- (delinquent boys) depressive and irritable feelings, insomnia, anorexia, hopelessness, helplessness, fears of dying/losing control, panic symptoms

Adolescent Social Discomfort
Content-based interpretive statements
- find it difficult to be around others, report being shy, avoid others, avoid initiating conversations, report embarrassment in a group, difficulty making friends
Empirically based interpretive statements
- introverted, withdrawn, social problems, low energy, symptoms of depression
- (inpatient girls) increased risk for suicidal behaviours
- (normative boys) avoid participation in school activities, less likely to use substances
- (delinquent boys) frequent/lethal suicide attempts, irritability, need for reassurance
- (normative girls) unlikely to use substances, unlikely to have behaviour problems, withdrawn, timid, few friends, depressed, eating problems

Adolescent Family Problems
Content-based interpretive statements
- family discord, jealousy, fault finding, anger, disagreements, limited communication, feel frequently punished by parents, do not accept home responsibilities, feel like can’t count on family, many beatings
Empirically based interpretive statements
- problems in family, discord, not the same asocial behaviours as A-con high scorers
- report parental marital problems, poor grades, school problems
- (normative girls) weight gain, job loss, fail exams
- parents report behaviour problems, externalizing and internalizing/somatic complaints, see boys as uncommunicative, secretive, self conscious, sad, lonely; see girls as cruel, destructive, prone to fight, immature, hyperactive, sad, secretive, self conscious
- treatment staff ratings: acting out descriptors, see boys as clinging, attention seeking, anxious, self blaming; see girls as acting out sexually

Adolescent School Problems
Content-based interpretive statements
- upset by things at school, poor grades, truancy, learning problems, negative attitudes, friends seen as pleasant, avoid participation in school activities
Empirically based interpretive statements
- academic and behaviour problems in school
- (clinical boys) run away, drug use history, history of sexual abuse possible
- (clinical girls) adademic underachievement, learning disabilities
- (delinquent boys) depressive feelings, concentration difficulties

Adolescent Negative Treatment Indicators
- attitudes unlikely to be conducive to psychotherapy, negative attitudes toward health/mental health professionals, do not believe others understand them, unwilling to discuss problems, unwilling to face problems, report insurmountable faults, do not assume responsibility for negative things in their lives
- treatment outcome studies are required to verify whether negative attitudes toward mental health professionals, ability and desire to change affect the course of psychotherapy

The MMPI-A Content Component Scales
- clusters of items within several scales
- e.g. Adolescent-Health Concerns (somatic complaints: GI, neuro, etc), can be broken down into component scales
- 31 subscales for 13 of the 15 MMPI-A content scales (all except Adol-Anx, and Adol-Obsess)
- can be used in similar ways to how the Harris-Lingoes subscales are used with the standard scales