A Test With Weak Psychometrics and a 15-Year-Old Client
A community agency asks you to administer a new 40-item 'School Anxiety Scale' (SAS) to clients ages 12-18. The publisher's manual reports a single normative sample of 212 college undergraduates, internal consistency of .61, and no test-retest data. The manual states that scores above the 75th percentile indicate 'clinically significant anxiety.' You are asked to evaluate 15-year-old Mai, a Hmong American student who has missed 18 days of school this semester. She answers 'sometimes' to most items, and her total score falls at the 82nd percentile of the college norm group. Her parents speak limited English; Mai says she is 'fine' and does not want them involved. The agency director tells you to 'just write it up-the school needs a diagnosis for an IEP.'
1. Should you use the SAS, and how should the 82nd-percentile score be interpreted?
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The SAS should not be used as the sole basis for a diagnosis or an IEP. The norms are college undergraduates, not adolescents ages 12-18, so Mai's score is being compared with the wrong reference group. Internal consistency of .61 is low for a clinical screener, and the absence of test-retest data means stability is unknown. The 75th-percentile cutoff appears arbitrary rather than validated against a diagnostic criterion. Mai's 'sometimes' responses may reflect language, cultural display rules, or response style rather than anxiety severity. A percentile rank also has a confidence interval; a single score near a cutoff is not decisive. Use the SAS only as a tentative screener, if at all, and interpret it alongside a clinical interview, school records, teacher reports, and a culturally and linguistically appropriate measure. Document the limitations clearly.
2. How do informed consent and parental involvement apply to Mai?
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As a 15-year-old, Mai cannot consent to assessment on her own in most jurisdictions; parental consent is generally required, along with Mai's assent. Explain the purpose, procedures, limits of confidentiality, and who will see the results in a way her parents can understand, using a qualified interpreter if needed. Mai's wish that her parents not be involved must be explored but does not override parental consent for a school evaluation. Clarify what will and will not be shared with the school and obtain a release consistent with FERPA. Ask Mai what she is worried about; her reluctance may signal family stress, stigma, or fear of school consequences. Do not promise secrecy you cannot keep. Document the consent process and Mai's assent or dissent.
3. How should you respond to the director's instruction to 'just write it up'?
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Do not write a report that overstates what the SAS can support. Explain to the director that the instrument's norms, reliability, and validity do not justify a diagnosis for a 15-year-old Hmong American student, and that an IEP decision requires a comprehensive evaluation, not a single questionable score. Offer an alternative: a full clinical interview, collateral information from teachers and parents with consent, review of attendance and academic records, and a validated measure with appropriate norms. Consult a supervisor or ethics committee if pressured, and document the concern and your recommendation. The ethical obligation is to promote accurate assessment and avoid misuse of tests, even when an administrator wants a quick answer. If the agency insists, clarify in writing what the score can and cannot mean.