Use of Standardized Methods

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For many clinicians (especially psychologists), self-report instruments (e.g., the Minnesota Multiphasic Personality Inventory [MMPI]) and clinician-administered psychological tests (e.g., the Wechsler intelligence scales, the Rorschach) are invaluable sources of information in the assessment phase. The majority of standardized measures have not been normed on American Indian or Alaska Native populations, however. Lacking such norms, it is difficult to judge whether elevated symptomatology indicate psychopathology or nonpathological cultural variation. For example, Pollack and Shore (1980) reported consistent elevations in the F, Pd, and Sc scales of the MMPI within urban Indian psychiatric patients regardless of gender, age, tribal affiliation, or diagnosis (including schizophrenia and depression). They concluded, "It appears that cultural influence overrides individual pathology and personality differences in influencing the pattern of the MMPI" (p. 948). In a similar vein, the commonly observed discrepancies between the Verbal and Performance Intelligence Quotients of the Wechsler scales might be an expression of a learning disability but could also indicate cultural differences in learning, environment, or language barriers (Manson etal., 1997).

Other doubts have been expressed about the cross-cultural validity of various personality and intellectual tests beyond lack of norms. As summarized by Suzuki and Kugler (1995), the following are the common concerns: (a) the content of items as well as constructs measured reflect White middle-class values; (b) minorities might not be as accustomed to test-taking, and issues of test-practice and motivation may influence test results (c) clinicians unfamiliar with the culture of the client may inadvertently stereotype the client and bias the results; and (d) oppression and discrimination may contribute to the elevation or depression of various scores rather than an individual deficit. Ideally, as proposed by Pollack and Shore (1980), "It is not only cultural norms for standard tests that need development but cultural research that identifies culturally appropriate instruments from the outset" (p. 949).

Given that norms are typically nonexistent and that such culturally appropriate instruments are also lacking, clinicians using standardized measures should approach results with caution. As a general rule, clinicians should interpret and report data consistent across measures in an assessment battery. For example, it is probably reasonable to conclude an American Indian male is depressed if he indicates depressed affect and other depressive symptoms such as insomnia during a clinical interview and testing further reveals an elevated D scale on the MMPI, a positive Depression Index on the Rorschach, and a very slow processing speed within the Performance subtests of the Weschler Adult Intelligence Scale (WAIS). As described below, however, clinicians should routinely utilize other sources of information beyond standardized measures and incorporate this data into any diagnostic formulation.

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