Evidence-based assessment/Vignettes/Jay

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Clinical description


Jay is a 22-year-old male undergraduate student at the University of North Carolina at Chapel Hill (UNC). Jay was previously diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). In college, Jay complained of having difficulties with sustaining attention, reading, inadequate study habits, and poor performance in his college courses (relative to his high school performance). He has been experiencing mood fluctuations. Jay has been feeling anxious for a long time. He says that he has "panic attacks" and "persistent worrying."

History of presenting a problem


Jay had previously been evaluated for Attention-Deficit/Hyperactivity Disorder (ADHD) and was diagnosed. In addition to attention and reading difficulties, Jay reported clinically significant disordered mood and fluctuations in mood (i.e., periods of “highs” and “lows”), and a strong family history of bipolar disorder. Finally, Jay reported a longstanding history of anxiety, including panic attacks and persistent worrying.



Initial treatment plan


Assessment Findings


Checklist Scores

Extended content

Select more specialized scales to refine probabilities


Updating probabilities


Critical items


Diagnostic Interview findings


Cognitive and Achievement Testing


(Not done as part of the evaluation; may be able to match up information later)

Let's see how we would apply the EBA principles to Arlene:

Shortlist of Probable Hypotheses


Based on Jay's age and the common clinical issues, here are the possible issues:

  • Attention problems
  • Anxiety disorders
  • Substance misuse should be another hypothesis, based again on its prevalence in his age group.
  • A mood disorder

Could add table with DLRS and revised probabilities, or leave them blank and have a "key" section?

Jay Common Dx Hypotheses (A) Starting Prob. (B) Broad Measure (D) Cross-informant (E) Confirmation (G) Treatment Phase (I), (J), (K)
Base Rate from Kessler et al. (2005) NCS-R Scale & Score DLR Revised Prob. EAY Check Next Test score DLR Revised Prob. MINI
Specific Phobia 0.13
PTSD 0.06
GAD 0.04 Generalized Anxiety Disorder Current
Panic Disorder 0.04 Panic Disorder Lifetime
Social Phobia 0.14
Separation Anxiety 0.02
Any Impulse Control Disorder ODD 0.10
CD 0.11
ADHD 0.08 Adult ADHD
Any Mood Disorder MDD 0.15 BDI Major Depressive Episode w/ Melancholic Features, Past
BP 0.06 MDQ KSADS Mania Scale? Hypomanic Episode
Dysthymia 0.02
Any Substance Abuse Disorder 0.17

Mention that these have DLRs. Also unpack the implications of agreement and disagreement for the client (and add a section about treatment implications of disagreement on the Conceptual Model Pages)

Mental Status and Clinical Observations


add content

Reliable Change Index


Pick a treatment target and specify what the RCI would be for it. Discuss how you would explain to Arlene

Nomothetic Benchmarks


A, B, Cs of Jacobson definitions. General stuff about limitations would go on the main concept page. Here it is focused on the client -- what are the benchmarks they will focus on? How explained to them?

Interpreting benchmarks


Minimum Important Difference (MID)


Note that this section is a dangler -- not originally called out in the 12 steps. Medium d as a rule of thumb from Streiner, Norman, & Cairney (2015). Could work from AUC to d to raw units as a way of estimating, since psychology hasn't done research on this yet. Might be able to back into it with studies that had CSQ and outcome data.

Client Goals & Tracking


These would be personal goals and idiographic measurement -- YTOPS, etc.

This would be traces such as coming to sessions, doing homework assignments. (Not sure of other specifics involved in current IPT protocols?)

YTOPS again and goal setting.

Revisit Jacobson benchmarks. Is there much chance of relapse? What things would the client need to pay attention to if they were going to nip that in the bud?

  1. Merikangas, Kathleen Ries; He, Jian-ping; Burstein, Marcy; Swanson, Sonja A.; Avenevoli, Shelli; Cui, Lihong; Benjet, Corina; Georgiades, Katholiki et al.. "Lifetime Prevalence of Mental Disorders in U.S. Adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A)". Journal of the American Academy of Child & Adolescent Psychiatry 49 (10): 980–989. doi:10.1016/j.jaac.2010.05.017. PMID 20855043. PMC PMC2946114. https://dx.doi.org/10.1016/j.jaac.2010.05.017.