Professional Documents
Culture Documents
Clinical
determining factor in clinical
judgments and actions.
Actuarial
method, the human judge is
eliminated and conclusions rest
solely on empirically
established relations between
data and the condition of
interest.
Actuarial assessment is not
synonymous with computerized
assessment.
Butcher, et.al, 2000
A computer-based test interpretation
(CBTI) system is actuarial only if its
interpretive output is wholly
determined by statistical rules that
have been demonstrated empirically
to exist between the output and the
input data
Sines, 1966
Computerized assessment would
amount to a computerized application
of clinical opinion—that is, the
application of a clinician’s (or group of
clinicians’) judgments, opinions, and
expertise to a particular set of data as
processed by the computer software.
Grove et al. (2000) proceeded to
compare clinical judgment with
what they termed mechanical
prediction
Only when benefits far outweigh the risks and the risks
minimized can the decision be socially acceptable.
Implications of
Computer-based
Administrations
A computer that has stored a bank of
achievement test items
of different difficulty levels can be programmed
to present items according to an algorithm or
rule.
For example, one rule might be “don’t present an item of the next
difficulty level until two consecutive items of the current difficulty level are
answered correctly.” Another rule might be “terminate the test when five
consecutive items of a given level of difficulty have been answered
incorrectly.”
Computerized adaptive testing (CAT) refers to
an interactive, computer-administered test
taking process wherein items presented to the
test taker are based in part on the test taker’s
performance on previous items.
The computer may not permit the test taker to continue with the
test until the practice items have been responded to in a satisfactory
manner and the test taker has demonstrated an understanding of the test
procedure.
A Compromise of
Sorts
Clinicians are capable of providing information that
computers simply cannot capture in the form of
frequency tables, but how such clinical information
is used becomes a key question. It would be good to rely
on mechanical prediction for coming up with
the optimal use of such clinical information in the form of
decision rules.
CONCLUSION
Ultimately, it is human hands that are responsible for
even the most eloquent computerized narratives, and
it is in human hands that the responsibility lies for
what further action, if any, will be taken. There is no
substitute for good clinical judgment, and the optimal
combination of actuarial methods and clinical
judgment must be identified for all types of clinical
decision making—including clinical decision making
that must be made as a result of neuropsychological
assessments.
References
Cohen and Swerdlik (2010). Psychological
Testing and Assessment: An Introduction to
Test and Measurement 7th Edition. McGraw-
Hill Primis. ISBN-10:0-39-011360-3