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What are the arguments regarding the use of the MMPI-2 vs. MMPI-A with adolescents?

 

Alex B. Caldwell, Ph.D.

 

What was the extent of the development of adolescent assessment with the original MMPI?

 

For the first 24 years of developing my MMPI interpretation system, there was only the original MMPI. There was extensive research showing good, validly interpretable profiles down to ninth grade/age 15. This included an extensive research program (books by Hathaway & Monachesi, 1953, 1961, 1963) based on the testing of over 15,000 ninth grade students in Minnesota around 1950. This included a major exploration of the true longitudinal prediction (rather than concurrent or post-diction) of subsequent juvenile delinquency. There was the work of Marks, Seeman, and Haller (1974), with special adolescent norms, and there was a large number of published individual studies. The score curves by age levels on the F scale show a small but gradual increase from 18 down to 15 but an increasingly steep slope below 15. My system contains a large number of internal adjustments for adolescence (especially regarding psychoticism lest it be too readily presumed to be chronic given the still developing age level). I actually ended up having to start the age adjustment process from less than 22 on down (except 49/94 code where age 21 is already adult).

 

With the revisions, what are the consequences of using one form or the other? When the MMPI-2 revision committee (Butcher, Dahlstrom Graham, Tellegen, & Kaemmer, 1989) developed the MMPI-2 revision, they decided to separate the adolescents, and they ended up setting cutoffs at up through age 17 or both age 18 and living at home as adolescent (use the MMPI-A) and age 19 on up or both 18 and not living at home as adult (use the MMPI-2). The main issue that the proponents of the MMPI-A (e.g., Archer, 1997, and others) have argued is that the adult form seriously over-pathologizes the teenager - so many get substantially elevated profiles. I have argued that the MMPI-A seriously under-pathologizes the adolescents - a quite sizeable proportion of adolescent psychiatric inpatients get normal range profiles. In truth I think each of us is partly right. My feeling is that the psychological and hormonal turbulence of adolescence really shows in the MMPI-2 scores, but comparing turbulent inpatients to an also relatively turbulent normative teen sample on the MMPI-A makes everyone look comparatively normal. In the end I feel that, with appropriate age allowances, the adult MMPI-2 codetype gives us a better basic understanding of the adolescents’ issues and behaviors as well as considerations as to their origins.

 

With adults we see long term qualities of behavior in the MMPI profiles, including childhood etiologic factors. What about adolescents? I do think that an adolescent profile should be thought of as much closer to a high speed photograph of a rapidly moving target, whereas an age 22+ adult profile can be much more of a slow speed, in-depth portrait. Such an upper age level is consistent with the early to mid-20's completion of the myelination of affective cerebral neurons; the inhibitory affective control systems are the last part of the brain to fully mature. This means we must be careful not to project undue stability or fixity over an extended future time to the behavioral implications of a teenage profile. Such parental assertions as, "Sometimes she’s so remarkably responsible, she’s like 11 going on 21," or "Today I swear he’s 18 going on 12," reflect how different an adolescent can be from one occasion to another. I think that as events in the adolescent’s life correspond emotionally to prior events, both ugly and beautiful, that those re-stimulations then determine the emotional state of that day (or whatever relatively brief time interval). In any case, my emphasis is that the goal is the most accurate and useful prediction of behavior we can generate, possibly with cues as to what prior emotional episodes are being re-aroused.

 

Which source of information, then, is more clinically workable? The original MMPI items feel very dated to today’s adolescents, but the MMPI-2 edits make it much more comfortable for them. The MMPI-A benefits from being a bit shorter (which they usually like) as well as having yet a little more comfortable wording for adolescents. Nevertheless, I believe that the very large amount of pattern or code type research on both adults and adolescents using the original version versus so comparatively little configural data on the MMPI-A favors the predictive power of the MMPI-2. This gives us the most useful information from the broadest research base and most extensive accumulation of clinical experience. This is not to say that this is an ideal solution because one still has to remind oneself to allow for the turbulence of adolescence and the greater potential for future change in the results obtained. Considering all this, in my interpretation service I continue to interpret MMPI-2 protocols from adolescents with all the internal age adjustments included. I do not encourage testing below age 15, although bright and mature 14 year-olds can often get profiles that are valid by all available criteria as well as being good "clinical fits."

 

References

 

Archer, R. P. (1997). The MMPI-A: Assessing adolescent psychopathology (2nd ed.). Mahwah, NJ: Erlbaum.

 

Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). MMPI-2: Manual for administration and scoring. Minneapolis: University of Minnesota Press.

 

Hathaway, S. R., & Monachesi, E. D. (1953). Analyzing and predicting juvenile delinquency with the MMPI. Minneapolis" University of Minnesota Press.

 

Hathaway, S. R., & Monachesi, E. D. (1961). An atlas of juvenile MMPI profiles. Minneapolis" University of Minnesota Press.

 

Hathaway, S. R., & Monachesi, E. D. (1963). Adolescent personality and behavior: MMPI patterns of normal, delinquent, dropout, and other outcomes.

Minneapolis" University of Minnesota Press.

 

Marks, P. A., Seeman, W., & Haller, D. L. (1974). The actuarial use of the MMPI with adolescents and adults. Baltimore: Williams and Wilkins.