Up Close With Dr. E

Diagnosing adolescent psychopathology

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You’re driving your car when suddenly, your dashboard engine light explodes with a red, “Warning!” What to do? Take your car to a mechanic who, after running diagnostic tests, will identify, and fix the problem. Simple.

Let’s now apply this process to diagnosing adolescent psychopathology (fancy word for brain-based psychiatric illness.) “Hmmm. No dashboard, no red warning lights, Help!”

The complexity of auto-diagnostics pales when compared to the teenage brain. Here’s why:

1. No two teens are alike. Unlike cars, where make and model are similar, each teen is unique.

2. Adolescents are developing organisms. Unlike autos, which are fully assembled from the factory, teens are in the throes of massive, developmental change.

Today’s article is about the use of a psychological test, which overcomes the abovementioned obstacles. What’s it called? The MMPI-A -Minnesota Multiphasic Personality Inventory for Adolescents.

Here’s your roadmap for today’s column.

1. Questions and answers about the MMPI-A.

2. Clinical case example.

3. Current Culture for teens.

Questions/Answers.

1. Since the MMPI-A is neither a blood test, nor a brain scan, how does it work?

Answer: It is a true/false test where the test answers are put into a computer program which has thousands of test profiles from both normal teens and confirmed cases of psychopathology (such as clinical depression or anxiety disorders.) This allows for profile comparisons.

2. What are MMPI-A code types? When two or more clinical scales are highly elevated, a code type is produced. In today’s clinical example, you’ll meet Anne, a 17-year-old girl with a 49-code type.

3. Can the MMPI-A give prognostic findings? Yes, test scores provide predictions about a teen’s future.

4. Can MMPI-A test results be used alone, without history or records, to make a diagnosis? No. Test results can be offset by unique or powerful talents and skills. In the clinical example, Anne has several abilities — good social skills, high intelligence — which counter-balance her 49-code type.

Clinical Case Example. (Today’s story is a fictional account of my internship at Riley Children’s Hospital in Indianapolis, where I was trained to use the MMPI-A by Dr. T.)

“Richard, here is a scored MMPI-A of Anne (17), your patient.” I looked at the test and said, “She has a 49-code type and, uh ...”

Dr. T plucked the test out of my grip and began, “The 49-code type occurs in 4% of female patients. Most are referred for problems with school truancy and conflicts with authority figures. 50% of these kids have legal problems due to shop-lifting, or runaways. 61% use alcohol and drugs. Your patient is high-risk for teen pregnancy, addiction, sexually transmitted diseases, and school failure. Without good treatment, she will wind up in jail, or worse, die young.”

Dr. T continued, “Like X-rays which detect broken bones, the MMPI-A can identify emotional wounds. But, be careful, it cannot tell you what caused her problems. To find that out, you must read this” — he handed over a stack of files, papers and records.

First Office Visit:

As I spread her records across my desk, my eyes landed on a photograph. Anne was standing in front of a large swimming pool, flanked by family. On a table, next to her was a birthday cake with candles ablaze. She wore a one piece, canary yellow swim suit. Around her neck hung blue ribbons and medals. Her smile was magnetic and her sapphire eyes and ash-blonde hair gave her a regal bearing. Plop, a crown on her head and behold, a dazzling miniature Princess Diana. I turned the photo over: July 3, 7th birthday party and swim meet.

As Anne entered my office, I said, “I’m Dr. E …” Daggers of fire shot from her eyes. “I know who you are,” she snapped. She was a rattlesnake coiled for combat. “You don’t know me, so how could you help me?”

I sat down and spoke softly, “My hope is you’ll tell me about yourself.” “Fat chance,” she snorted.

“What if I do know you? What if you asked me questions and I answered all of them correctly?” She hissed, “When’s my birthday?”

“Today is your 17th birthday, and you were born at 10:03 a.m., July 3.”

“What’s my favorite color?” “Canary yellow,” I said. She learned toward me and asked, “How did you know that?” I grabbed the photo, pointed to her as a seven-year-old, and said, “She told me.”

Over the next year, I worked with Anne to overcome her destructive anger, which had been identified by her MMPI-A 49-code type.

Current Culture for Teens:

Conclusion: It’s been 25 years since I left Riley Hospital, and the MMPI-A has proved to be a valuable diagnostic tool. What’s changed in the past quarter century? Today’s children and adolescents are swimming in a culture whose currents have become deeper, darker, and deadlier. How do I know this?

There are four photographs hanging on my office wall. They are in chronological order. The first is my paternal grandfather, a pediatrician, who immigrated from Sweden in 1913, and who practiced until 1950. The second is of my father, a pediatrician who practiced from 1950 up to his death in 2016. The third is my photo, and the fourth is a sentence which reads, “Three generations of helping children.” I grew up listening to conversations about children. One theme I heard went like this: “If you want to measure the greatness of a nation, look at how they treat their most powerless and vulnerable citizens – children.” (The content of this article is for educational purposes only, and should not be used as a substitute for treatment by a professional. The characters in this story are not real. Names and details have been changed to protect confidentiality.)

References: 1. MMPI-A, Archer, 1992, Erlbaum Associates. 2. MMPI-2, MMPI-A, Pope, Butcher, 2000. American Psychological Association.

 

Dr. Richard Elghammer contributes his column each week to the Journal Review.

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