Kaplan + Sadock's Synopsis of Psychiatry, 11e

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5.5 Personality Assessment: Adults and Children

Table 5.5-3 Projective Assessment Procedures for Children

Name

Age Range

Description

Rorschach Inkblot Test Children’s Apper- ception Test (CAT)

5 years–Adult- hood

Consists of ten inkblots, some colored and others achromatic, used as basis for eliciting asso- ciations that are revealing of disrupted personality development. Two versions of the CAT—animal and human—depict characters in various social situations and are used to elicit stories from children. Younger children are felt to identify more readily with the animal figures, while older children are usually presented the human figures. Scor- ing and interpretation is based on psychodynamic theory. 11 picture cards focus on parent–, peer–, and sibling–adolescent interaction, pulling for themes of physical and sexual abuse, neglect, peer acceptance, loneliness, depression, drug use, and domestic violence. Two versions are available—one depicting white teenagers and the other black teenagers. 16 picture cards—with parallel male and female versions depicting Caucasian, black, or Hispanic characters—are designed to elicit information about two independent dimensions: adaptive social perception (which is a developmental measure) and the presence of mal- adaptive or atypical social perception (which is a clinical measure). The responses indicate where a child is on a continuum of social understanding. The revision has an expanded age range (from 6 to 18 years) and a standardized scoring system based on updated, stratified normative data to aid interpretation. Multicultural apperception test with 23 color picture cards (11 of which are sex specific) depicting minority (Hispanic or black) or nonminority characters. Measures ten personality functions (e.g., aggression, interpersonal relations, and self-concept), 18 cognitive functions (e.g., reaction time, fluency, sequencing, and imagination), and seven affective functions (e.g., happy, sad, angry, and fearful). Has an objective scoring system and normative data based on a diverse cultural and ethnic sample. Various versions exist, from individual drawings of human figures, a house, and tree to kinetic drawings of family. These are simple, cost-effective measures that provide information on chil- dren’s perceptions of self and relationships with others. Especially useful with children who have difficulty with verbal expression. Objective scoring available for some drawings (e.g., human figures), but interpretation of other types of projective drawings is often subjective. A number of different formats available, each providing a sentence stem or initiating a story, after which the child is asked to complete the sentence or story. Provides information on such factors as interpersonal relationships and dynamics, self perception, wishes, and worries.

3–10 years

Adolescent Apper- ception Cards

12–19 years

Roberts Appercep- tion Test for Children–2 nd edition (RATC-2)

6–18 years

Tell-Me-A-Story (TEMAS)

5–18 years

Projective

3 or 4 years

Drawings

through ado- lescence

Sentence and Story Completion Tasks

4 or 5 years

through ado- lescence

structural characteristics of the child’s responses. The 2 nd edi- tion of the RATC is now available, and it provides normative data (stratified by geographic region, sex, ethnicity, and paren- tal education) on a sample of 1,000 children and adolescents, ages 6 to 18 years, to aid in clinical interpretation. The RATC-2 asks the child or adolescent to tell a story in response to each of 16 test pictures that represent important interpersonal themes. The RATC-2 assesses two independent dimensions: adaptive social perception (which is a developmental measure) and the presence of maladaptive or atypical social perception (which is a clinical measure). The responses indicate where a child is on a continuum of social understanding. Interpretation of the RATC-2, like that of other projective measures, is based on the assumption that children presented with ambiguous drawings of children and adults in everyday interaction will project their typical thoughts, concerns, conflicts, and coping styles into the stories that they create. The RATC-2 has three parallel versions of the test pictures— one for Caucasian children, one featuring African American children, and the other depicting Hispanic children. Objective Personality Measures Objective approaches to child personality assessment typically have straightforward test stimuli and clear instructions regard- ing completion of the tests, as opposed to projective approaches, which typically use more unstructured, ambiguous test stimuli.

to those pictured in the animal version. During administration, the cards are presented individually in the numbered order of the card (because certain cards were designed for sequential impact). The child is asked to tell a story about each picture (e.g., what is going on, what happened before, and what will happen next). There is some debate about the use of prompts with young children and whether such prompts (e.g., “How did the story end?”) may contaminate important projective infor- mation. Generally, prompts are often necessary to help the young child understand what is expected. Young children have a tendency to merely label or describe portions of the picture and may not understand the concept of telling a story with a beginning, middle, and conclusion. However, the clinician must always guard against overly intrusive or helpful prompts that guide the child’s responses in a particular direction or suggest a specific format for the story. The various scoring protocols for the CAT have focused on the analysis of ego functions and evaluation of the relative use of various defense mechanisms. However, qualitative interpretation is also made based on recur- rent or sequential themes and determination of identification figures, while taking into consideration the child’s family and case history information. Roberts Apperception Test for Children—2 nd Edi- tion.  The original Roberts Apperception Test for Children (RATC) was developed specifically for children and provided a standardized system for scoring the thematic content and