Steven T. Kane, PhD, is the author of the Kane Learning Difficulties Assessment™ (KLDA™). The KLDA screens college students for learning difficulties and ADHD. This week, the PAR blog sits down with the author to learn more about the development of the KLDA and the feedback he has received from clinicians on the impact it has made.
What initially inspired you to develop the KLDA?
Before becoming a professor and researcher, I was employed in a university disability resource center as a psychologist who specialized in learning disabilities and ADHD. I was also previously employed at three of the most diverse community colleges in California. In each of these settings, I saw literally hundreds of students who should have been screened for learning and attentional challenges but never were. I was also quite frankly shocked by the number of individuals I saw who clearly suffered from some form of learning or attentional difficulties as adults yet were never screened or tested in the K–12 system. Testing for a learning disability and/or ADHD is very expensive and simply out of reach for the majority of our most at-risk college students, especially those of color and those from low socioeconomic backgrounds. I also found it troubling that almost none of these students were ever screened for anxiety disorders or memory challenges. Thus, my goal was to develop a screening assessment that was very affordable and easy to take, preferably via the internet.
How does the KLDA differ from other competitive measures?
There are not a lot of similar measures, which is, again, one of the main reasons why we developed the KLDA. There are two or three other measures that assess study skills, motivation, etc., but not the key academic skills and executive functioning skills the KLDA assesses.
What are some important things clinicians should know about the KLDA?
First, the KLDA is normed on a very large and diverse population from across the U.S. and Canada. Second, the KLDA was completed by more than 5,000 people over the internet for free as we performed factor analyses, perfected item development, and more. Third, the KLDA is very affordable, essentially self-interpreting, and can be administered quickly via the Internet. Most respondents finish the assessment in about 10 minutes as the items are written at about a fourth- through sixth-grade reading level. The KLDA can also guide the assessment process and inform which lengthier diagnostic assessments should be administered. Finally, the KLDA is a great discussion prompt to encourage clients to talk about their difficulties across different environments.
What feedback have you received from users of the KLDA?
Practitioners and test-takers have found the assessment very useful and easy to administer (especially via the web in a pandemic!). It leads to very interesting discussions that the respondent has often never had with anyone before.
Anything else you think is important for people to know about your product?
The KLDA is a very flexible product. The assessment can be used by individual clinicians to screen a client before they even meet for the first time. It’s been used by community colleges and universities as part of their orientation process to screen at-risk students before they fail. Study skills and student success instructors have found the KLDA extremely useful to administer to a classroom as part of a group assignment. Thanks to PARiConnect, the KLDA can be easily administered to large groups of individuals online at a very low cost.
Related Article: ADHD & ACADEMIC CONCERNS DURING A PANDEMIC
This week, Sierra Iwanicki, PhD, project director, spoke to Mark A. Blais, PsyD, and Samuel Justin Sinclair, PhD, the coauthors of the SPECTRA: Indices of Psychopathology to gain more insight into the development and uses of this instrument.
What motivated you to create the SPECTRA?
Mark A. Blais, PsyD: Several factors combined to motivate the SPECTRA’s development. Like most psychologists, we were concerned about the shortcomings of the DSM’s categorical diagnostic system (e.g., excessive comorbidity, arbitrary thresholds, and within-disorder heterogeneity) and the problems this system created for psychological assessment. Therefore, we were excited by the emergence of multivariate research exploring the structure of adult psychopathology. And as this research accumulated, we became convinced that an instrument based on a hierarchical–dimensional model of psychopathology would have great utility for clinical assessment. Unfortunately, to our knowledge, none of the existing psychological inventories were fully congruent with the hierarchical model. Confident that the hierarchical model of psychopathology had significant clinical utility, we decided to develop the SPECTRA. With funding from the Massachusetts General Hospital’s Department of Psychiatry, we undertook a rigorous development process that resulted to the SPECTRA’s publication in the spring of 2018.
How does the SPECTRA differ from other broadband psychological inventories?
Blais: The SPECTRA differs from other broadband inventories conceptually and interpretatively. Based on contemporary hierarchical models, the SPECTRA was designed to assess psychopathology at three clinically meaningful levels or bandwidths. The 12 clinical scales provide a narrow-band assessment of constructs similar to DSM disorders. The three higher-order scales reorganize symptoms into the broader dimensions of Internalizing, Externalizing, and Reality-Impairing psychopathology. At the broadest level, the SPECTRA’s Global Psychopathology Index (GPI) yields a single overarching measure of psychiatric burden and vulnerability. Interpretively, the SPECTRA’s three levels of assessment provide unique information about a patient’s clinical presentation, course of illness, and prognosis. We suggest employing an interpretive strategy that moves from the global, GPI, through to the three broad dimensions, and down to the specific clinical scales. This approach allows the examiner to write a concise description of severity and prognosis (GPI), complexity and treatment focus (dimensional scales), and current symptom expression (clinical scales).
What kinds of settings/contexts might the SPECTRA have utility for mental health providers?
Samuel Justin Sinclair, PhD: As our understanding of psychopathology and diagnosis have advanced with the emergence of the hierarchical–dimensional model, we believe an instrument like the SPECTRA has broad clinical utility. Clinically speaking, the SPECTRA organizes psychopathology in a unique way that informs a more differentiated understanding of etiology, complexity, and burden. As such, we see utility in comprehensive outpatient clinical assessments (like the ones we conduct in our own practice), where the referral questions and clinical presentations are usually complex. In this context, the SPECTRA offers important information about current symptom expression (e.g., what specifically the patient is experiencing), as well as valuable information about complexity (e.g., elevations in multiple spectra domains) and general burden (i.e., the p factor). Such information is valuable for treatment planning, both in terms of specific targets to focus on (e.g., PTSD symptoms) and also breadth and intensity of services that may be indicated. We also believe the SPECTRA has utility for inpatient or acute treatment contexts, where a more focal psychological assessment may be useful. Given the SPECTRA’s lower patient burden (i.e., it is roughly 75% shorter than most other broadband instruments), it may be ideal in these specific types of acute care settings. In fact, we recently published a study assessing the validity and utility of the SPECTRA in an inpatient setting, and the results suggested it performed quite well. Similarly, we have also recently explored the validity of the SPECTRA in a sample of incarcerated individuals with serious mental illness and found good evidence for validity when compared with the specific type and number of SCID-5 diagnoses. Finally, given the SPECTRA’s ability to assess psychopathology and functioning at different levels, we believe the instrument has considerable utility in treatment/outcomes monitoring. As a psychometrically sound, low-burden assessment conceptually aligned with contemporary models of psychopathology and research, we believe there are a wide array of different application possibilities with an instrument like the SPECTRA.
What is the p factor and how is it relevant to clinical assessment?
Blais: The p factor represents one of the most exciting and valuable insights revealed by contemporary psychopathology research. Similar to Spearman’s general factor of cognitive ability (e.g., g factor), the p factor is an overarching general factor of psychopathology. As the g factor reflects overall cognitive ability, the p factor seems to represent, from low to high, overall psychiatric burden. Therefore, it has the potential to be a reliable single index of a patient’s overall psychiatric burden and impairment. The p factor emerges statistically from the positive correlations observed among measures of psychopathology. The statistical p factor is robust and widely replicated. Our conceptual understanding of the p factor is still evolving, but research shows that subjects high on p factor suffer more functional impairment, have greater comorbidity, evidence neurocognitive dysfunction, and are more likely to experience a suboptimal or atypical response to treatment. The SPECTRA, with GPI, is the only broadband inventory specifically designed to generate a validated p-factor measure.
How does the SPECTRA assess psychopathology in a way that is useful for clinicians?
Sinclair: As noted above, the SPECTRA provides unique clinical information at the different levels of the psychopathology hierarchy. At the lowest level, clinicians are able to see where and to what degree patients are expressing primary psychopathology—at the level of the DSM-5 syndromes. However, at the spectra level, clinicians are better able to see how a person’s psychopathology may cluster—and whether this tends to reflect more within-domain (or spectra) symptomatology, or across domains. This information may inform clinical decision making in different ways. For example, to the extent that a person is highly distressed, anxious, and depressed—with multiple elevations across these scales, but all within the Internalizing domain—specific classes of pharmacologic and/or types of psychotherapeutic interventions may be indicated. However, in cases where psychopathology is expressed across multiple spectra (with higher p-factor scores), it may signal greater levels of diagnostic complexity, burden, and impairment in functioning—which would suggest that treatment may need to be multimodal, sequenced, and of longer duration and/or intensity. In contrast to other broadband instruments that assess clinical constructs (e.g., depression, mania) as specific or independent entities, the SPECTRA’s hierarchical–dimensional assessment of psychopathology makes it unique—offering valuable information across different levels of psychopathology.
What are some important things clinicians should know about the SPECTRA?
Sinclair: We believe the conceptual model described earlier is probably what makes the tool most unique and best aligned with contemporary models of psychopathology. However, the instrument is also quite brief—and at just 96 items, it may be something to consider when testing conditions or context do not allow for longer instruments. Likewise, in addition to the core clinical scales and hierarchical dimensions that are assessed, the SPECTRA also contains several supplemental scales assessing suicidal ideation, cognitive concerns, and adaptive psychosocial functioning. The cognitive concerns scale was designed to be disorder agnostic and is meant to assess the types of general cognitive problems (e.g., organization/attention, memory, language) people may experience respective of etiology. This scale helps assess level of functioning, as perceived cognitive difficulties negatively impact motivation, persistence, and confidence. It also functions as a brief screener that can inform decisions about pursuing more formal neuropsychological assessment. In addition, the SPECTRA’s adaptive psychosocial functioning scale was also developed to assess environmental resources (financial and housing), coping strengths, and social support—all of which may be useful for informing treatment recommendations and estimating prognosis. The psychosocial functioning scale was developed from a more positive psychology perspective. We wanted the SPECTRA to focus not only on deficits, but also on strengths and resources. The SPECTRA’s supplemental scales provide clinically valuable information above and beyond psychopathology—information that allows us better insight into a person’s functioning and where and how we might be able to help as psychologists.
Learn more about the SPECTRA.
The National Association of School Psychologists (NASP) Annual Convention will be held February 26 to March 1 in Atlanta and the PAR booth will be the place to be! If you’re going to NASP, please stop by to say hello! We’ll have product samples, giveaways, and you can win a BRIEF2 or FAR kit! Plus you can meet some of your favorite authors!
Here’s a link to see when our authors will be available at our booth.
There are also a number of informative sessions being offered that are relevant to your favorite PAR products, many of them being presented by PAR authors. Here is a link to a complete listing with dates and times. We hope you’ll make time to attend one or more of them.
But wait—there’s more! PAR will be offering special discounts on any purchases made at the PAR booth during NASP. You’ll save 15% on your order and we’ll include free ground shipping!
We look forward to seeing you in Atlanta!