Professional Psychology: Research and Practice Copyright 2002 by the American Psychological Association, Inc.

2002, Vol. 33, No. 5, 446 – 453 0735-7028/02/$5.00 DOI: 10.1037//0735-7028.33.5.446

Child and Adolescent Psychological Assessment: Current Clinical Practices

and the Impact of Managed Care
Mary Louise Cashel
Southern Illinois University at Carbondale

Which psychological testing measures are clinical child and adolescent psychologists most commonly
using? How has managed care influenced the practice of assessment for these professionals? This study
provides survey data from 162 child practitioners employed in independent practice and in hospital,
outpatient, and school-based settings throughout the United States. The results demonstrate marked
consistency with recent surveys of clinicians working with adults, and a list of the 30 most frequently
utilized measures is provided. Over 40% of the sample reported significant limitations in psychological
testing due to managed-care policies. Strategies for maintaining an assessment practice are discussed.

Over the past 25 years, the professional practice of psychology
has undergone dramatic changes attributed to the medicalization of
mental illness, the expansion of efforts to obtain reimbursement for
services through health insurance, and the evolution of managed-
care organizations (Acklin, 1996). In fact, since the passage of the
Health Maintenance Organization Act in 1973, clinicians have
gradually witnessed a remarkable truncation of a wide range of
psychological services that were formerly available in many health
care plans (Butcher, 1997; Dana, Conner, & Allen, 1996; Miller,
1996). Recent articles have suggested that insurance policy con-
straints have placed significant limitations on psychological as-
sessment practice (Butcher, 1997; Piotrowski, Belter, & Keller,
1998; Stout, 1997) and, at least in some instances, have led to the
improper diagnosis and treatment of patients (Miller & Luft,
1994). Notably, the majority of test utilization studies have pri-
marily focused on procedures for adult clients (Watkins, 1991). As
the field struggles to reconcile continuing changes in health service
provision, similar studies evaluating current practices in child and
adolescent assessment and the impact of managed care are clearly
needed (Schaefer, 1999).
Test utilization studies of practicing clinicians have a lengthy
history within the field of psychological assessment, beginning in
1935 (Louttit & Brown, 1947). Results from national surveys
conducted as early as 1961 and 1969 (Lubin, Wallis, & Paine,
1971; Sundberg, 1961) suggested that the most commonly used
measures included the Wechsler Adult Intelligence Scale (WAIS),
the Rorschach, the Thematic Apperception Test (TAT), the
Bender–Gestalt Visual Motor Test, the Minnesota Multiphasic
Personality Inventory (MMPI), and the Draw-A-Person (DAP)
test. Subsequent surveys conducted in 1982 and 1989 of psychol-
MARY LOUISE CASHEL received her PhD in clinical psychology in 1997
from the University of North Texas. She is an assistant professor of clinical
child psychology at Southern Illinois University at Carbondale. Her re-
search interests focus on child and adolescent assessment and treatment
interventions for delinquent youth.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Mary
Louise Cashel, Department of Psychology, Mailcode 6502, Southern Illi-
nois University, Carbondale, Illinois 62901. E-mail: mcashel@siu.edu
ogists in diverse practice settings (Lubin, Larsen, & Matarazzo,
1984; Piotrowski & Keller, 1989) yielded strikingly consistent
findings and demonstrated the continuing popularity of these mea-
sures. Some variation across settings was noted, such as more
limited use of the TAT and DAP in Veterans Affairs hospitals and
college counseling centers (Lubin, Larsen, Matarazzo, & Seever,
1985). The most recent survey of practicing clinical psychologists
(Camara, Nathan, & Puente, 2000) listed the following as the 10
most commonly administered measures: the WAIS–R, MMPI,
Wechsler Intelligence Scale for Children (WISC), Rorschach,
Bender–Gestalt, TAT, Wide Range Achievement Test (WRAT),
House–Tree–Person (H-T-P) Technique, Wechsler Memory
Scale—Revised, Millon Clinical Multiaxial Inventory (MCMI),
and Beck Depression Inventory (tied with the MCMI). Clearly, the
evaluation of intelligence, personality, visuomotor skills, and ac-
ademic achievement has remained a prominent aspect of diagnos-
tic assessment over time.
Studies evaluating the effects of managed health care are much
more recent. Piotrowski et al.’s (1998) survey of 137 psychologists
indicated that 72% reported changes in test usage over the past 5
years that were directly due to managed care. Specifically, the
participants acknowledged conducting less testing, using fewer
tests, or sometimes a combination of both. Many of them indicated
that the measures most frequently discontinued were among those
they considered most important as diagnostic tools, such as the
MMPI, the WAIS/WISC, the Rorschach, the TAT, and the Millon
inventories. The authors concluded that the majority of respon-
dents perceived a very negative impact on testing practices due to
managed-care changes, but they did not indicate whether the
respondents felt that such limitations significantly impaired their
ability to make sound diagnostic decisions.
The studies discussed above evaluated psychological testing
practices for adults exclusively, or in some cases combined age
groups comprising adults, adolescents, and more rarely, children.
Considerably fewer studies have examined assessment procedures
for children specifically, and fewer still, for adolescents (Kam-
phaus, Petoskey, & Rowe, 2000). The first and most comprehen-
sive survey of child clinical psychologists (Tuma & Pratt, 1982)
reported that the most commonly used measures included intelli-

446
 CHILD AND ADOLESCENT ASSESSMENT
gence tests (primarily the Wechsler scales), various achievement
measures, human figure drawings, the Bender–Gestalt, the TAT,
and the Rorschach. Subsequent studies of training practices for
clinical child psychology internships (Elbert & Holden, 1987) and
specialized assessments, namely, of attention-deficit/hyperactivity
disorder (Rosenberg & Beck, 1986), yielded findings that contin-
ued to reflect the prominence of these measures.
Child assessment studies surveying the practice of school psy-
chologists (Goh & Fuller, 1983; Hutton, Dubes, & Muir, 1992;
Prout, 1983) also reported findings very similar to those of Tuma
and Pratt (1982). In addition to the measures noted above, behavior
ratings, behavioral observations, the Sentence Completion Test,
the H-T-P Technique, and Kinetic Family Drawings were very
popular. Reschly’s (1998) review of the three most recent school
psychologist surveys yielded several interesting trends. The
Wechsler scales, Bender–Gestalt, DAP, and Woodcock Johnson
Tests of Achievement consistently remain among the most fre-
quently used measures. However, use of structured observations
and behavior rating scales such as the Conners Parent and Teacher
Rating Scales, the Behavior Assessment System for Children
(BASC), and the Child Behavior Checklist (CBCL) has become
increasingly prevalent—more so than projective measures such as
the TAT and the Rorschach.
Archer, Maruish, Imhof, and Piotrowski (1991) conducted the
only published study to date designed specifically to evaluate
adolescent assessment practices. The majority of the 165 practic-
ing clinicians in their sample reported using the WISC, Rorschach,
Bender–Gestalt, and TAT most frequently in their testing batteries.
The 10 most commonly used measures overall included the MMPI,
Sentence Completion, Kinetic Family Drawing, Human Figure
Drawings, H-T-P Technique, and the WRAT. Thus, their findings
were largely consistent with those of previous adult and child
studies.
Various researchers have observed a comparative lack of child-
focused assessment surveys addressing the views of clinical child
as opposed to adult practitioners (Archer et al., 1991; Kamphaus et
al., 2000; Watkins, 1991). Moreover, none of the child assessment
studies previously discussed examined the impact of managed care
on specific test-selection practices. Researchers have speculated
that mental health insurance benefits for children are more exten-
sive (Miller, 1996); however, there is no evidence to either support
or refute this claim. The specific effect of insurance constraints on
test utilization for child and adolescent assessment thus remains
unknown.
Survey of Child and Adolescent Assessment Practices
This study sought to examine the current practice of child and
adolescent assessment and clinician-perceived effects of managed
care. The participants included 727 members of the American
Psychological Association (APA)—specifically, 227 members of
Division 53 (Clinical Child Psychology), 250 members of Divi-
sion 16 (School Psychology), and 250 members of Division 54
(Pediatric Psychology). These participants were randomly selected
by including every 10th member listed on the division rosters in
the 2000 edition of the Directory of the American Psychological
Association (APA, 2000). The divisions were chosen on the basis
of their explicit focus on children and adolescents.
447
Questionnaire and Procedure
A three-page questionnaire was mailed to each selected partic-
ipant in April 2001 that addressed the following: (a) participant
training background, clinical experience, current assessment prac-
tice, and theoretical orientation; (b) frequency of test usage for 45
listed measures; (c) test usage of the same 45 measures for child
versus adolescent populations specifically; (d) changes in test
usage due to managed care; and (e) the overall impact of managed
care on diagnostic assessment. The 45 measures listed in the
questionnaire were chosen on the basis of previous child and
adolescent test utilization studies (Archer et al., 1991; Tuma &
Pratt, 1982).
A self-addressed, stamped envelope was enclosed to facilitate
the return of surveys. A second attempt to contact the selected
participants was conducted in July 2001 by electronic mail (E-
mail). All individuals with E-mail addresses listed in the APA
Directory were sent a second invitation to participate in the study.
They were informed that they could either directly request a copy
of the survey with an E-mail response or they could download it
from a specified Web site. This may not have been the most
effective approach, but departmental costs impeded a second stan-
dard mailing.
Of the 727 surveys originally mailed in this study, 177 were
completed and returned by the recipients, and 10 were returned
undeliverable. Two recipients called and informed the researcher
that they were no longer practicing; one person noted that he was
mistakenly listed as belonging to the division. Regarding the
E-mails, 102 were undeliverable due to invalid addresses. Twenty-
four recipients responded via E-mail and indicated that they were
not qualified to participate in the study because they were retired,
no longer seeing children and adolescents, or not conducting
assessments. In addition, many untabulated E-mail responses in-
dicated that the participant had already completed and mailed the
survey. Among the 177 returned surveys, 15 were incomplete, with
notes attached providing reasons similar to those described above.
Thus, the adjusted response rate was 28% and reflects the opinions
of 162 child and adolescent clinicians. This response rate closely
approximates those reported by Archer et al. (1991), Piotrowski et
al. (1998), and Rosenberg and Beck (1986): 36%, 32%, and 30%,
respectively. The total number of respondents for this sample (N ⫽
162) nearly replicates the total sample number reported by Archer
et al. (N ⫽ 165) and exceeds the number of participants reported
by Piotrowski et al. (N ⫽ 137).
Frequency of test-usage ratings were made according to the
following scale: never, rarely, some, frequently, and always. Rep-
licating the procedures described by Archer et al. (1991) and Lubin
et al. (1985), I calculated a total mention score for each test by
summing the total number of ratings provided in each usage
frequency category. A weighted score was also derived for each
test by summing the number of ratings in each usage frequency
category, multiplied by the numerical weight assigned to it:
WS ⫽ 关共n ⫻ 0 ⫽ never) ⫹ (n ⫻ 1 ⫽ rarely) ⫹ (n ⫻ 2 ⫽ some)
⫹ (n ⫻ 3 ⫽ frequently) ⫹ (n ⫻ 4 ⫽ always)].
Percentages of test-usage endorsements for children and for ado-
lescents were examined separately. Finally, ratings of whether test
448 CASHEL
usage had either increased or decreased explicitly because of
managed-care constraints were summarized.
Sample Characteristics
The vast majority of the 162 respondents had completed doc-
toral degrees (PhD ⫽ 87%, PsyD ⫽ 7.4%, “other” ⫽ 5.6%). A
little over 75% of the sample (n ⫽ 148) had been in practice for 11
years or more, and approximately 43% (n ⫽ 69) had been in
practice for over 20 years. Only 9% (n ⫽ 10) had less than 5 years
of experience. In terms of training background, 61.7% (n ⫽ 100)
indicated training in clinical child psychology, and 49.4% (n ⫽ 80)
reported broader training in clinical psychology. The remainder
were listed as follows: counseling (12.3%, n ⫽ 20), educational
psychology (13.6%, n ⫽ 22), and school psychology (43.8%, n ⫽
71). There was considerable overlap among the categories because
many respondents checked more than one, most commonly clinical
child, clinical, and school psychology.
With regard to practice settings, 29% (n ⫽ 47) reported working
in a medical center or hospital, 11.1% (n ⫽ 18) in an outpatient
clinic, 17.3% (n ⫽ 28) in a school system, 21.6% (n ⫽ 35) in a
college or university setting, 6.8% (n ⫽ 11) listed “other,”
and 12.3% (n ⫽ 20) did not specify. Only 1.9% (n ⫽ 3) reported
working in a community mental health center. The sample was
almost equally divided between those who worked in independent
practice (51.2%, n ⫽ 83) and those who did not (48.8%, n ⫽ 79).
The majority of respondents worked in more than one setting; 50
individuals (30.8%) were exclusively in independent practice. The
specific division membership was neither listed as a question on
the survey nor color coded before mailing, which was an oversight.
On the basis of the comparatively small percentage of individuals
working in school settings, it appears that the response rate from
Division 16 was the lowest.
With regard to theoretical orientation, the majority of respon-
dents (51.9%, n ⫽ 84) described themselves as cognitive–
behavioral. The remaining percentages were as follows: behavioral
(7.4%, n ⫽ 12), interpersonal (4.9%, n ⫽ 8), psychodynamic
(9.3%, n⫽ 15), and eclectic (24.7%, n ⫽ 40). Because the content
of the survey was developed on the basis of previous studies in
which gender and ethnicity were not reported, these data were not
obtained.
Assessment Practices and Psychological Test Usage
The mean percentage of time spent by the respondents conduct-
ing psychological assessments was 27.3%. The median percentage,
however, was closer to 15%. The respondents were asked to
describe the frequency with which they use psychological assess-
ment measures as indices of treatment outcome. Approxi-
mately 17.9% indicated that they never formally assess treatment
outcome, 48.1% indicated they sometimes would, 20.4% indicated
they frequently do, and 8.0% routinely (always) assess treatment
outcome. These percentages were very similar for those exclu-
sively in independent practice: The mean time spent conducting
psychological assessments was 33.3%, with a median of 20%;
approximately 20% never used assessment measures for evaluat-
ing treatment outcome; 56% sometimes would; 18% frequently
did; and only 4% reported always assessing treatment outcome.
Given the relatively low response rate, it is very likely that selected
division members who chose not to participate were less fre-
quently engaged in psychological assessment, or perhaps not at all.
If this were the case, and had they been included in the analysis,
then reported mean and median percentages would clearly have
been lower.
The respondents were asked to rank the following socioemo-
tional assessment approaches by order of importance for their
current clinical practice: clinical interview, behavioral observa-
tions, behavior ratings, projective tests, and self-report inventories.
The ranking percentages for each of these techniques are shown in
Table 1. It appears that for most respondents in this sample, the
clinical interview is viewed as most critical, followed by observa-
tions, behavioral ratings, self-report inventories, and projective
tests. There were significant differences in ratings among respon-
dents describing themselves as psychodynamic in orientation,
however. Not surprisingly, they rated projective tests as more
important, ␹2(5, N ⫽ 162) ⫽ 17.57, p ⬍ .01, and self-report
measures as less important, ␹2(5, N ⫽ 162) ⫽ 20.40, p ⬍ .01,
when compared with the rest of the sample. Overall rankings from
psychodynamic respondents suggest that they view the clinical
interview as most critical, followed by behavior ratings, with
behavioral observations and projective measures given equal
weight above self-report instruments. No other differences based
on theoretical orientation were noted.
Table 2 lists the frequency ratings for specific test usage in order
by decreasing weighted score. These ratings are for test usage with
children and adolescents (youth) combined. Clearly, the WISC,
which received a weighted score almost three times greater than
the median score for all 45 measures, is the most prevalently used
measure among all practicing child clinicians within this sample.
Behavior rating scales (specifically the CBCL and Conners Parent
and Teacher Rating Scales) appear among the top 10 most highly
rated measures, whereas the Rorschach and TAT obtained consid-
erably lower weighted scores. The Bender–Gestalt, DAP, Sentence
Completion, and Woodcock Johnson (if the Teacher Rating Form
is combined with the CBCL) remain in the top 10, along with the
new addition of the Wechsler Individual Achievement Test.
Adolescent clinical psychology is quickly emerging as a unique
discipline with many commonalities but also with distinctly dif-
ferent considerations and theoretical underpinnings as compared
Table 1
Ranking Percentages of Social–Emotional Assessment
Procedures for Youth
Rankingsa
Procedure 1 2 3 4 5
Clinical interview 71.0 11.7 8.0 4.3 3.1
Behavioral observations 11.1 51.9 17.9 13.6 2.5
Behavioral rating forms 9.3 17.9 36.4 25.9 7.4
Self-report inventories 2.5 9.3 22.2 41.4 21.6
Projective tests 4.9 6.8 11.1 11.1 59.9
Note. The percentages do not total to 100 due to missing data from 3–10
respondents/per procedure. N ⫽ 162.
a
1 ⫽ highest; 5 ⫽ lowest.
 CHILD AND ADOLESCENT ASSESSMENT 449

Table 2
Test Usage Ratings for the Top 30 Assessment Instruments for Youth

Usage ratings (N ⫽ 162)

Instrument a b c d e TM WS

Wechsler Intelligence Scale for Children 21 6 33 72 30 141 408

Child Behavior Checklist 38 20 31 39 34 124 335
Sentence Completion 41 25 37 47 12 121 288
Conners’ Parent and Teacher Rating Scales 42 20 44 46 10 120 286
Teacher Report Form 70 4 22 44 22 92 268
Draw-A-Person Test 56 25 27 38 16 106 257
Bender–Gestalt Test 55 33 30 25 19 107 244
Wechsler Individual Achievement Test 61 23 34 39 5 101 228
Beery VMI 60 26 36 31 9 102 227
House–Tree–Person Technique 70 23 28 23 18 92 220
Woodcock Johnson Tests of Achievement 70 17 30 38 7 92 219
Vineland Adaptive Behavior Scales 48 43 49 18 4 114 211
Children’s Depression Inventory 66 22 38 33 3 96 209
Kinetic Family Drawing 65 27 35 28 7 97 209
Behavioral Assessment for Children 81 15 24 30 12 81 201
Peabody Picture Vocabulary Test 60 37 41 22 2 102 193
Wide Range Achievement Test 72 24 38 26 2 90 186
Rorshach Inkblot Test 70 42 20 24 6 92 178
Thematic Apperception Test 72 42 23 20 5 90 168
Youth Self-Report Form 88 18 26 23 7 74 167
Minnestota Multiphasic Personality Inventory—A 73 32 39 17 1 89 165
Beck Depression Inventory 67 49 26 18 2 95 163
Stanford–Binet Intelligence Scale—IV 73 40 31 15 3 89 159
Children’s Apperception Test 84 38 28 9 3 78 133
Continuous Performance Test 99 19 18 26 0 63 133
Revised Manifest Anxiety Scale 103 11 29 19 0 59 126
Reynolds Adolescent Depression Scale 108 17 23 13 1 54 106
Kaufmann Assessment Battery for Children 90 45 23 4 0 72 103
Roberts Apperception Test 107 23 19 12 1 55 101
Piers–Harris Children’s Self Concept Scale 104 24 27 7 0 58 99
Kaufmann Brief Intelligence Test 111 22 19 9 1 51 91

Note. a ⫽ never; b ⫽ rarely; c ⫽ some; d ⫽ frequently; e ⫽ always; TM ⫽ total mentions; WS ⫽ weighted

score (sum n ⫻ numerical weight of ratings a ⫽ 0, b ⫽ 1, c ⫽ 2, d ⫽ 3, e ⫽ 4); VMI ⫽ Visual–Motor
Integration.

with clinical child and adult psychology. In recognition of these
distinctions, Division 53 recently changed its name to the Society
of Clinical Child and Adolescent Psychology. In order that simi-
larities among testing practices for children versus adolescents
may be evaluated, the percentages of respondents endorsing test
usage with these groups are listed separately in Table 3. Measures
used more frequently with children include the Beery Develop-
mental Test of Visual–Motor Integration, Conners Parent and
Teacher Rating Scales, Kinetic Family Drawing, the Peabody
Picture Vocabulary Test, the Personality Inventory for Children,
Roberts Apperception Test, and the Vineland Adaptive Behavior
Scales. Measures used more frequently with adolescents include
the MMPI—Adolescent, the Millon Adolescent Clinical Inven-
tory, the Reynolds Adolescent Depression Scale, the TAT, and the
Youth Self Report.
Impact of Managed Care
Managed-care-related changes in test usage are also reported in
Table 3. The percentages of respondents reporting either more or
less test usage are listed by measure. The WISC, Rorschach, and
MMPI appear to be the most negatively affected, with 22.8%,
16.7%, and 11.7% of the sample reporting less utilization of these
measures, respectively. In contrast, a small percentage of the
sample (6.2%) reported an increase in usage of the CBCL. The
impact on the majority of specific test usage was negligible for the
most part. The respondents were additionally asked to evaluate the
impact of managed care on their general ability to conduct psy-
chological testing and to accurately diagnose their clients. For
psychologist testing, 34.6% (n ⫽ 56) reported no impact at
all, 46.3% (n ⫽ 75) reported a negative impact, and 1.2% (n ⫽ 2)
reported a positive impact (the remainder did not respond). Re-
garding their ability to accurately diagnose clients, 47.5% (n ⫽ 77)
reported no impact, 29% (n ⫽ 47) reported a negative impact,
and 2.5% (n ⫽ 4) reported a positive impact (the remainder did not
respond). Chi-square analyses were performed to evaluate whether
respondents working specifically in independent practice settings
were more negatively affected; these analyses were not significant.
The reported percentages for those in independent practice and
otherwise were very similar. Considering again the relatively low
response rate, it is possible that those most dramatically influenced
450 CASHEL

Table 3
Sample Percentages of Test Utilization With Children and Adolescents and Managed-Care-
Related Changes

HMO-related
Test utilization with changes

Instrument Adolescents Children Less More

Beck Depression Inventory 47.5 9.9 4.3 3.1

Beery VMI 23.5 55.6 8.6 0.6
Behavioral Assessment for Children 33.3 42.0 1.2 5.6
Bender–Gestalt Test 42.0 55.6 6.2 1.9
Benton Visual Retention Test 11.1 11.1 1.2 0.0
Children’s Apperception Test 6.8 41.4 7.4 0.0
Children’s Behavior Checklist 52.5 65.4 4.3 6.2
Children’s Depression Inventory 22.8 49.4 4.3 4.3
Children’s Depression Rating Scale 4.3 11.1 0.6 0.6
Conners’ Parent and Teacher Rating Scales 47.5 65.4 3.1 4.3
Continuous Performance Test 26.5 30.9 4.9 1.9
Draw-A-Person Test 35.8 56.2 4.9 1.2
Halsted Reitan Battery 9.3 8.6 3.1 0.0
High School Personality Questionnaire 6.8 0.6 0.0 0.0
House–Tree–Person Technique 32.1 48.8 4.9 1.2
Kaufman Brief Intelligence Test 20.4 25.3 1.2 3.1
Kaufmann Assessment Battery for Children 9.3 37.0 4.9 0.0
Kinetic Family Drawing 27.8 51.9 3.7 0.0
Louisville Behavior Checklist 1.9 2.5 0.0 0.0
Luria–Nebraska Neuropsychological Battery 3.7 4.3 1.2 0.0
Matching Familiar Figures 3.1 6.8 1.2 0.0
Millon Clinical Adolescent Inventory 24.7 1.9 5.6 0.6
Minnestota Multiphasic Personality Inventory—A 45.7 4.9 11.7 1.2
Peabody Picture Vocabulary 29.0 52.5 6.2 0.6
Personality Inventory for Children 7.4 25.9 3.1 0.0
Personality Inventory for Youth 5.6 4.9 0.6 0.0
Piers–Harris Children’s Self Concept Scale 14.8 29.0 3.1 0.6
Problem Behavior Inventory 4.3 0.6 0.0 0.0
Revised Manifest Anxiety Scale 23.5 29.6 2.5 1.9
Reynolds Adolescent Depression Scale 29.0 8.0 2.5 1.9
Roberts Apperception Test 15.4 27.8 4.9 0.0
Rorshach Inkblot Test 48.1 42.6 16.7 0.6
Sentence Completion 59.9 57.4 8.6 0.6
Stanford–Binet Intelligence Scale—IV 29.0 45.7 8.6 0.0
Teacher Report Form 43.8 51.9 3.1 4.3
Tell Me a Story 3.7 8.6 1.2 0.0
Test of Nonverbal Intelligence 20.4 24.1 5.6 0.0
Thematic Apperception Test 43.2 24.7 11.7 0.0
Vineland Adaptive Behavior Scales 36.4 63.0 4.9 1.2
Wechsler Individual Achievement Test 47.5 52.5 13.0 0.0
Wechsler Intelligence Scale for Children 69.8 74.7 22.8 0.0
Wide Range Achievement Test 42.0 42.0 11.7 1.9
Wisconsin Card Sorting Test 17.3 11.7 3.1 0.0
Woodcock Johnson Tests of Achievement 42.6 45.7 12.3 0.0
Youth Self-Report Form 43.2 12.3 3.1 1.9

Note. N ⫽ 162. VMI ⫽ Visual–Motor Integration.

by managed care were overwhelmed with their own documenta-
tion responsibilities and unable to take the time to complete the
survey. Finally, no differences as a function of theoretical orien-
tation were noted.
Conclusions and Implications for Clinical Practice
Clinicians and health service providers have an obligation to
offer no less than the current standard of care for their clients. They
also have an obligation to provide effective care, consistent with
their training and expertise. One of the primary goals of this study
was to evaluate the current assessment procedures and test-
selection practices of child clinicians employed in a variety of
settings. The respondents in this study constituted a generally
representative sample of individuals working in independent prac-
tice and in a combination of other settings, such as hospitals or
medical centers, outpatient clinics, and colleges or universities.
With regard to their preferred test selection, in many ways little has
changed over the past 30 years, which is consistent with predic-
 CHILD AND ADOLESCENT ASSESSMENT
tions made by Watkins (1991). We continue to see marked simi-
larity between the results of this survey and the most commonly
administered measures for children reported as many as 20 years
ago (Prout, 1983; Tuma & Pratt, 1982). We also see striking
congruence with past and recent adult survey findings (Camara et
al., 2000; Lubin et al., 1984; Sundberg, 1961).
The correspondence between the current results and the most
recent surveys of school psychologists is both interesting and in
many ways reassuring. Reschly (1998) highlighted the increasing
significance placed on behavioral observations and behavioral
rating forms among school-based professionals. These trends
clearly are not restricted to school settings. Similar to Reschly’s
study, the present study found the CBCL and Conners Parent and
Teacher Rating Scales to be among the top 10 measures used by
respondents. The Behavioral Assessment Scale for Children
(BASC) was listed not far below. Rosenberg and Beck (1986)
noted that behavior ratings scales are empirically superior methods
for evaluating disruptive behavior disorders, especially when com-
pared with traditional clinical interviews. Thus, it is hoped that
some of these changes reflect a growing awareness of the need to
critically evaluate the reliability and validity of assessment mea-
sures. However, it is also likely that the ease of administration and
computerized software available for the CBCL and BASC, for
example, have facilitated their widespread use.
Clinicians and academicians have long exhibited conflicting
attitudes toward the value of projective measures (Garb, 1999;
Hunsley & Bailey, 1999; Karon, 2000; Lally, 2001; Piotrowski,
1984; Viglione & Hilsenroth, 2001; Weiner, 1983, 1999). Whereas
academicians have argued against their reliability and validity,
clinicians have traditionally found them to be very helpful for case
conceptualization and treatment planning. The present results con-
tinue to demonstrate the enduring popularity of projective mea-
sures such as the DAP and Kinetic Family Drawing, which might
be attributed to the rapport-building potential of these tests, at least
where children are concerned. Most children, especially those
under 9 or 10 years of age, enjoy and are very familiar with
drawing tasks. These tests are also very simple to administer and
do not necessarily involve elaborate scoring systems. Alterna-
tively, Watkins (1991) suggested that the continued popularity of
our “core” group of tests may reflect the training that the majority
of practicing clinicians receive. Most APA-approved internship
programs continue to teach these measures (Elbert & Holden,
1987; Stedman, Hatch, & Schoenfeld, 2001), and most individuals
will practice what they know. Clearly some changes are occurring,
however, as indicated by reductions in the utilization of the Ror-
schach and TAT, much of which appear to be driven by managed
care (Piotrowski et al., 1998).
The Wechsler scales remain the most popular measures used
across settings for adult, child, and adolescent assessments. How-
ever, they are also the measures most frequently cited as discon-
tinued due to managed-care limitations. This leaves the practicing
clinician, for whom intellectual assessments are critical, in a quan-
dary and perhaps lends even greater support to Kamphaus et al.’s
(2000) recommendation that such individuals become more famil-
iar with the recently standardized and validated WISC–III short
forms (Campbell, 1998). As Kamphaus et al. suggested, clinicians
may also wish to consider using other abbreviated measures, such
as the Kaufman Brief Intelligence Test (K–BIT) or the Wechsler
451
Abbreviated Scales for Intelligence. Recent reliability coefficients
reported for the K–BIT are exceptionally high (Eisenstein &
Englehart, 1997).
Many, although not all, of the clinicians in this sample reported
significant limitations placed on their ability to conduct psycho-
logical testing by managed-care policies. Moreover, many be-
lieved that their ability to make sound diagnostic decisions was
seriously constrained. This finding is markedly similar to the
findings of Piotrowski et al. (1998) and raises pressing questions
for the future of the field. The ability to conduct evaluations based
on standardized and empirically supported psychological testing
measures has traditionally been one of the unique roles of the
professional psychologist. Maintaining this role is important, and a
variety of researchers and writers have made specific suggestions
as to how this can be accomplished.
Schaefer (1999) urged clinicians to adopt a proactive approach
and educate managed-care reviewers on the importance of mental
health assessments. He suggested pursuing a series of steps that
involve the following: (a) discussing with the utilization manager
the need for assessment; (b) requesting peer review if denied; (c)
filing a written or second-level appeal requiring the involvement of
consultants outside the health care company; and (d) complaining
to the state department overseeing insurance regulation if benefits
are not approved. Schaefer acknowledged that these efforts may
appear laborious and inordinately time consuming but argued that
this is the only way clinicians can facilitate change and ensure the
future of psychological assessment.
It is likely, however, that many clinicians would find this
confrontational approach impractical and ultimately ineffective.
Camara et al. (2000) emphasized the need to adopt more creative
strategies and recommended incorporating assessment as a central
component within interventions and treatments such that testing is
no longer considered an optional or supplementary service. This
will be most successfully achieved when the clinician can demon-
strate that conducting assessments for treatment-planning purposes
significantly enhances diagnostic accuracy and/or reduces the cost
or length of treatment. These suggestions are consistent with recent
recommendations from APA (Meyer et al., 1998) and other re-
searchers in the field (Groth-Marnat, 1999; Stout, 1997). It is thus
encouraging that the majority of respondents in this sample re-
ported incorporating formal assessment measures in the evaluation
of treatment outcome for their clients at some level.
Eismann et al. (1998) recommended adopting a broader cam-
paign intended to educate lobbyists, legislatures, and the public
regarding the benefits of comprehensive psychological assessment.
Again, this requires identifying and publicizing the circumstances
under which assessment is demonstrably effective and appropriate.
Managed-care companies are driven by economics and are most
likely to respond to those who control funding sources and policy
regulation. Psychologists are often individualists, working inde-
pendently. However, to negotiate change effectively, we need to
come together as a group.
Finally, Kamphaus et al. (2000) recommended that those who
wish to maintain a child or adolescent assessment practice should
make every effort to work with schools, or at the very least adopt
testing procedures that are consistent with those used in the
schools. They noted that the special education population is grow-
ing rapidly, making the availability of professionals who can
452 CASHEL
provide comprehensive assessments a necessity. To provide ser-
vices that are maximally useful and informative for the schools,
psychologists should stay abreast of developments, such as new
measures used in these settings. They especially advocated famil-
iarity with the newer behavior rating scale technology.
The present findings raise several important and unanswered
questions. This survey did not address which measures clinicians
are using for specific purposes, such as differential diagnosis of
cognitive, mood, or behavioral disorders. It was not possible to
identify which measures are used most prevalently in what set-
tings. Respondents did not indicate such details as how many of
their clients have had benefits denied, by how many different
companies, or under what circumstances. Respondents were also
not asked under which circumstances benefits have been approved.
This information may prove very valuable to clinicians and to
policymakers. Controlled studies evaluating the efficacy of com-
prehensive assessments for improving diagnostic accuracy, treat-
ment planning, and reducing time or costs necessary for treatment
are needed.
In conclusion, as noted by countless academicians, practitioners,
and policymakers, change within the field of psychology is on the
horizon. This directly affects the area of psychological assessment,
among others. As child clinicians, we must equip ourselves with
the most current and empirically supported assessment tools. We
also should ready ourselves to function as advocates, defending the
rights of children to individual and comprehensive assessment
where indicated.
References
Acklin, M. W. (1996). Personality assessment and managed care. Journal
of Personality Assessment, 66, 194 –201.
American Psychological Association. (2000). Directory of the American
Psychological Association. Washington, DC: Author.
Archer, R. P., Maruish, M., Imhof, E. A., & Piotrowski, C. (1991).
Psychological test usage with adolescent clients: 1990 survey findings.
Professional Psychology: Research and Practice, 22, 247–252.
Butcher, J. N. (Ed.). (1997). Personality assessment in managed health
care. New York: Oxford University Press.
Camara, W. J., Nathan, J. S., & Puente, A. E. (2000). Psychological test
usage: Implications in professional psychology. Professional Psychol-
ogy: Research and Practice, 31, 141–154.
Campbell, J. M. (1998). Internal and external validity of seven Wechsler
Intelligence Scale for Children—Third Edition short forms in a sample
of psychiatric inpatients. Psychological Assessment, 10, 431– 434.
Dana, R. H., Conner, M. G., & Allen, J. (1996). Quality of care and cost
containment in managed mental health: Policy, education, research,
advocacy. Psychological Reports, 79, 1395–1422.
Eisenstein, N., & Engelhart, C. I. (1997). Comparison of the K–BIT with
short forms of the WAIS–R in a neuropsychological population. Psy-
chological Assessment, 9, 57– 62.
Eisman, E. J., Dies, R. R., Finn, S. E., Eyde, L. D., Kay, G. G., Kubiszyn,
T. W., et al. (1998). Problems and limitations in the use of psychological
assessment in contemporary healthcare delivery: Report of the Board of
Professional Affairs Psychological Assessment Work Group: Part 1.
Washington, DC: American Psychological Association.
Elbert, J. C. & Holden, E. W. (1987). Child diagnostic assessment: Current
training practices in clinical psychology internships. Professional Psy-
chology: Research and Practice, 18, 587–596.
Garb, H. N. (1999). Call for a moratorium on the use of the Rorschach
Inkblot Test in clinical and forensic settings. Assessment, 6, 313–317.
Goh, D. S., & Fuller, G. B. (1983). Current practices in the assessment of
personality and behavior by school psychologists. School Psychology
Review, 12, 240 –243.
Groth-Marnat, G. (1999). Current status and future directions of psycho-
logical assessment: Introduction. Journal of Clinical Psychology, 55,
781–785.
Hunsley, J., & Bailey, J. M. (1999). The clinical utility of the Rorschach:
Unfulfilled promises, and an uncertain future. Psychological Assess-
ment, 11, 266 –277.
Hutton, J. B., Dubes, R., & Muir, S. (1992). Assessment practices of school
psychologists: Ten years later. School Psychology Review, 21, 271–284.
Kamphaus, R. W., Petoskey, M. D., & Rowe, E. W. (2000). Current trends
in psychological testing of children. Professional Psychology: Research
and Practice, 31, 155–164.
Karon, B. P. (2000). The clinical interpretation of the Thematic Appercep-
tion Test, Rorschach, and other clinical data: A reexamination of statis-
tical versus clinical prediction. Professional Psychology: Research and
Practice, 31, 230 –233.
Lally, S. J. (2001). Should human figure drawings be admitted into court?
Journal of Personality Assessment, 76, 135–149.
Louttit, C. M., & Brown, C. G. (1947). Psychometric instruments in
psychological clinics. Journal of Consulting Psychology, 11, 49 –54.
Lubin B., Larsen, R. M., & Matarazzo, J. D. (1984). Patterns of psycho-
logical test usage in the United States. American Psychologist, 39,
451– 454.
Lubin, B., Larsen, R. M., Matarazzo, J. D., & Seever, M. (1985). Psycho-
logical test usage patterns in five professional settings. American Psy-
chologist, 40, 857– 861.
Lubin, B., Wallis, R., & Paine, C. (1971). Patterns of psychological test
usage in the United States: 1935–1969. Professional Psychology: Re-
search and Practice, 2, 70 –74.
Meyer, G. J., Finn, S. E., Eye, L. D., Kay, G. G., Kubiszyn, T. W.,
Moreland, K. L., et al. (1998). Benefits and costs of psychological
assessment in health care delivery: Report of the Board of Professional
Affairs Psychological Assessment Work Group: Part 1. Washington,
DC: American Psychological Association.
Miller, I. J. (1996). Managed care is harmful to outpatient mental health
services: A call for accountability. Professional Psychology: Research
and Practice, 27, 349 –363.
Miller, I. J., & Luft, H. S. (1994). Managed care plan performance since
1980: A literature analysis. Journal of the American Medical Associa-
tion, 271, 1512–1519.
Piowtrowski, C. (1984). The status of projective techniques: Or “wishing
won’t make it go away.” Journal of Clinical Psychology, 40, 1495–
1502.
Piotrowski, C., Belter, R. W., & Keller, J. W. (1998). The impact of
managed care on the practice of psychological testing: Preliminary
findings. Journal of Personality Assessment, 70, 441– 447.
Piotrowski, C., & Keller, J. W. (1989). Psychological testing in outpatient
mental health facilities. Professional Psychology: Research and Prac-
tice, 20, 423– 425.
Prout, H. T. (1983). School psychologists and social emotional assessment
techniques: Patterns in training and use. School Psychology Review, 12,
377–383.
Reschly, D. J. (1998, August). School psychology practice: Is there
change? Paper presented at the 106th Annual Convention of the Amer-
ican Psychological Association, San Francisco.
Rosenberg, R. P., & Beck, S. (1986). Preferred assessment methods and
treatment modalities for hyperactive children among clinical child and
school psychologists. Journal of Clinical Child Psychology, 15, 142–
147.
Schaefer, M. (1999). Mental health assessment of young children in a
 CHILD AND ADOLESCENT ASSESSMENT 453

managed care environment. Child and Adolescent Psychiatric Clinics of
North America, 8, 425– 437.
Stedman, J. M., Hatch, J. P., & Schoenfeld, L. S. (2001). Internship
directors’ valuation of preinternship preparation in test-based assessment
psychotherapy. Professional Psychology: Research and Practice, 32,
421– 424.
Stout, C. E. (Ed.). (1997). Psychological assessment in managed care. New
York: Wiley.
Sundberg, N. D. (1961). The practice of psychological testing in clinical
services in the United States. American Psychologist, 16, 79 – 83.
Tuma, J. M., & Pratt, M. J. (1982). Clinical child psychology practice
and training: A survey. Journal of Clinical Child Psychology, 11,
27–34.
Viglione, D. J., & Hilsenroth, M. J. (2001). The Rorschach: Facts, fictions,
and future. Psychological Assessment, 13, 452– 471.
Watkins, C. E. (1991). What have surveys taught us about the teaching and
practice of psychological assessment? Journal of Personality Assess-
ment, 56, 426 – 437.
Weiner, I. B. (1983). The future of psychodiagnostics revisted. Journal of
Personality Assessment, 47, 451– 461.
Weiner, I. B. (1999). What the Rorschach can do for you: Incremental
validity in clinical applications. Assessment, 6, 327–339.
Received October 29, 2001
Revision received May 20, 2002
Accepted May 23, 2002 䡲

Call for Nominations

The Publications and Communications (P&C) Board has opened nominations for the
editorships of Contemporary Psychology: APA Review of Books, Developmental Psychol-
ogy, and Psychological Review for the years 2005–2010. Robert J. Sternberg, PhD, James L.
Dannemiller, PhD, and Walter Mischel, PhD, respectively, are the incumbent editors.
Candidates should be members of APA and should be available to start receiving
manuscripts in early 2004 to prepare for issues published in 2005. Please note that the P&C
Board encourages participation by members of underrepresented groups in the publication
process and would particularly welcome such nominees. Self-nominations are also encour-
aged.
Search chairs have been appointed as follows:

• Contemporary Psychology: APA Review of Books: Susan H. McDaniel, PhD,

and Mike Pressley, PhD
• Developmental Psychology: Joseph J. Campos, PhD
• Psychological Review: Mark I. Appelbaum, PhD

To nominate candidates, prepare a statement of one page or less in support of each

candidate. Address all nominations to the appropriate search committee at the following
address:

Karen Sellman, P&C Board Search Liaison

Room 2004
American Psychological Association
750 First Street, NE
Washington, DC 20002-4242

The first review of nominations will begin November 15, 2002. The deadline for accept-
ing nominations is November 25, 2002.