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Minnesota Multiphasic Personality Inventory

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M
Minnesota Multiphasic Personality
Inventory for Adolescents
Robert P. Archer1 and Elizabeth M. A. Wheeler2
1
Department of Psychiatry and Behavioral
Sciences, Eastern Virginia Medical School,
Norfolk, VA, USA
2
Central State Hospital, Petersburg, VA, USA
Overview
This entry focuses on the history and current use
of the two forms of the Minnesota Multiphasic
Personality Inventory (MMPI) relevant to the
evaluation of adolescents (i.e., the MMPI-A and
the MMPI-A-RF). Particular focus is placed on
the utility of these tests, especially as it relates to
the evaluation of troubled youth. The discussion
reviews the uses of the MMPI-A and MMPI-A-
RF in a variety of contexts and overviews the
research literature that is available for the support
of these test instruments. The implications of this
MMPI literature for the understanding of adoles-
cent development and psychopathology will also
be presented.
# Springer International Publishing Switzerland 2016
R.J.R. Levesque (ed.), Encyclopedia of Adolescence,
DOI 10.1007/978-3-319-32132-5_256-2
Development of the MMPI, MMPI-A,
and MMPI-A-RF
Work on the Minnesota Multiphasic Inventory
(MMPI) was originally begun in the late 1930s
by Hathaway and McKinley, and the test was
originally published in 1943. The primary moti-
vation for developing the MMPI stemmed from
Hathaway and McKinleys interest in developing
a standardized method of evaluating psychologi-
cal functioning among adult medical patients
receiving treatment at the University of Minnesota
Hospitals. While developed to assess adult psy-
chopathology, Hathaway and McKinley included
respondents as young as age 16 in their original
normative sample. Hathaway clearly had a strong
interest in the use of the MMPI to explore adoles-
cent development and psychopathology. In the
late 1940s, Hathaway and Monachesi began the
collection of the largest MMPI-A dataset ever
obtained on adolescents. This longitudinal study
was designed to establish relationships between
MMPI ndings obtained from 15,000 adolescents
in 86 Minnesota communities and their eventual
development of behavior problems.
In the late 1980s, work began on developing a
unique form of the MMPI specically designed
2 Minnesota Multiphasic Personality Inventory for Adolescents
for adolescents, resulting in the publication of the
Minnesota Multiphasic Personality Inventory-
Adolescent (MMPI-A) in 1992 (Archer 2005).
The Minnesota Multiphasic Personality
Inventory-Adolescent-Restructured Form
(MMPI-A-RF) was published in 2016 and is the
newest instrument in the MMPI family for the
assessment of psychopathology among adoles-
cents (Archer et al. 2016).
Using the MMPI-A
The MMPI-A (Butcher et al. 1992) is a 478-item
true/false questionnaire designed to assess psy-
chopathology among adolescents ages 1418,
inclusive. The MMPI-A may be selectively used
with 12- and 13-year-old adolescents who have
sufcient reading and cognitive ability to respond
meaningfully to the items. The MMPI-A requires
approximately a sixth-to-seventh-grade reading
level, and MMPI-A norms are based on the
responses of 1,620 14- through 18-year-old ado-
lescents. The MMPI-A is widely used to evaluate
and describe the psychological functioning of
adolescents along standardized dimensions of
psychopathology. For this purpose, a clinician
may compare an adolescents MMPI-A test scores
against those obtained from the MMPI-A norma-
tive sample, with the mean value for the normative
sample reected in a T-score of 50 for all MMPI-A
scales, and standard deviations established as
10 T-score points across all scales. If an adoles-
cent exhibits clinical levels of psychopathology
(e.g., T  65 or 1.5 standard deviations above the
normative mean score), the clinician may consult
the clinical literature from the MMPI-A to identify
the most appropriate descriptive statements for
that adolescent. The administration of the
MMPI-A may also be repeated during the treat-
ment process to provide the clinician with an
estimate of the amount of change in the adoles-
cents functioning associated with treatment
efforts. Additionally, however, the MMPI-A is
also widely used in the evaluation of adolescents
in juvenile justice systems, including the evalua-
tion of adolescents prior to their adjudication to
help inform sentencing decisions as well as
following placement in correction settings or
juvenile delinquency programs to determine
needed rehabilitation services. Additionally, the
MMPI-A is also used to assess psychopathology
among adolescents with medical conditions, prob-
lems in educational settings, and a wide variety of
other problems (e.g., eating disorders, victims of
sexual abuse). Since the ten basic clinical scales
are very similar between the original form of the
MMPI and the MMPI-A, a considerable amount
of the 50 years of research done with adolescents
using the original MMPI can be carried over to
this revised form (Archer 2005).
Using the MMPI-A-RF
The MMPI-A-RF is a new instrument designed to
help in the identication and description of psy-
chopathology among adolescents. The
241 MMPI-A-RF items are a subset of the
478 MMPI-A item pool. The 241-item length of
the MMPI-A-RF may serve as an important factor
in successful test administration with adolescents.
The reduction in test length provided by the
MMPI-A-RF, however, was not the primary
objective of the development of this test. The
MMPI-A-RF was developed to improve the dis-
criminant validity achievable by the MMPI-A
scales by reducing the confounding inuence of
the extensive scale item overlap and by rening
the target or core components of the MMPI-A-RF
scales. This process was designed to produce
shorter scales in the MMPI-A-RF, with these
scales producing comparable convergent validity
as MMPI-A scales, but with improved discrimi-
nant validity. The MMPI-A-RF is composed of
48 scales, six validity, three higher order, nine
restructured clinical, 25 specic problems, and
revised versions of the MMPI-A PSY-5 scales.
In addition, 14 critical item sets are provided
including ve depression/suicidal ideation items.
Although the MMPI-A-RF items are a subset of
the MMPI-A item pool, the structure of the
MMPI-A-RF was informed by the scale structure
and underlying constructs found in the Minnesota
Multiphasic Personality Inventory-2-Restructured
Form (MMPI-2-RF). However, the development
Minnesota Multiphasic Personality Inventory for Adolescents
of the MMPI-A-RF also placed an emphasis on
creating scales uniquely sensitive to adolescent
developmental issues. Similar to the MMPI-A,
the MMPI-A-RF is a broad-spectrum instrument
designed to assess psychological functioning of
the adolescent for two major purposes. The
MMPI-A-RF, like the MMPI-A, may be used to
assess the adolescents current psychological
functioning, as well as through repeated adminis-
trations to evaluate changes in the adolescents
functioning across time.
Adolescent Development
Many theorists have described adolescence as a
period of emotional and behavioral upheaval. The
American psychologist, G. Stanley Hall, for
example, described adolescence as a period of
storm and stress. During this period adolescents
display considerable behavioral and emotional
turbulence as they modied behavioral patterns
established during childhood in order to achieve
a higher level of maturation and development
(Hall 1904). Hall recognized that this heightened
level of behavioral and emotional stress was
uniquely associated with normal adolescent
development and not necessarily an index of prob-
lematic adolescent development or a marker of
future mental health problems.
The impulsive, asocial, and risk-taking atti-
tudes and behaviors associated with adolescence
may be related to neuroanatomical characteristics
of this stage of development, as revealed by
recently improved brain imaging techniques.
Neurological studies across the past two decades
have opened a new window into understanding
adolescents cognition and moral reasoning, as
well as the basis of their apparent lack of planning
ability and predisposition to engage in risk-taking
behaviors. Studies have shown that the frontal
cortex area of the adolescent brain is the last
portion of the brain to reach mature development.
A study by the National Institute of Health, for
example, indicated that an adolescents frontal
lobe development is not completed until at least
age 22. Frontal lobe functioning has been directly
related to activities involving judgment and the
3
inhibition of impulsive behaviors. Changes occur-
ring in the frontal cortex of adolescents include
the pruning of excess neural connections and
increasing myelination of frontal cortex neurons.
Both of these physiological processes serve to
increase the speed of cognitive processing and
the overall quality of decision-making and
abstract reasoning function.
In addition to data collected through brain
imaging studies, it is clear that adolescence is a
time of profound physical and hormonal changes.
Judy Cameron has pointed out the possible rela-
tionship between hormonal and physical develop-
ment and changes in brain chemistry. She has
observed that hormonal changes associated with
puberty may also result in changes in neural sys-
tems, culminating in dramatic physical changes in
the adolescents body that occur over a relatively
short period of time (i.e., the adolescent growth
spurt). Research by other investigators has
shown that hormonal changes appear to be related
to self-esteem, mood, concentration, and the pres-
ence or absence of aggressive behaviors during
adolescence.
Implications from MMPI Findings
There is substantial data from the MMPI, MMPI-
A, and MMPI-A-RF which underscore that ado-
lescence is a unique period of development and
that adolescents characteristically report beliefs,
attitudes, and behaviors that differ from those
reported by most adult respondents. For example,
if adult norms are used in interpreting adolescent
MMPI response patterns, there is consistent and
convincing data that antisocial and psychotic
symptomatology tend to be overemphasized,
even in evaluations of normal adolescents. In par-
ticular, substantial research has shown that ado-
lescents without evidence of signicant
psychopathology consistently endorse many
more items indicative of psychopathology than
do adults. Normal adolescents especially endorse
those items related to antisocial attitudes or behav-
iors, family conict, persecutory ideas, alienation,
and manic symptoms related to restlessness,
4 Minnesota Multiphasic Personality Inventory for Adolescents
hyperactivity, and disinhibition (Archer 2005,
2016).
What is occurring during adolescent develop-
ment that sets this period of the life span apart
from other development stages? Archer (2005)
observed that a number of developmental theo-
rists have provided important information on this
topic. Jean Piaget, for example, viewed adolescent
development from the perspective of genetic epis-
temology, i.e., developmental changes that occur
in the process of adolescents acquisition and
organization of knowledge. Piaget proposed that
adolescents develop the ability to think abstractly,
including the ability to generate useful hypotheses
regarding a relationship between objects or
events. Piaget viewed the adolescent as obtaining
the ability to view the world in an abstract, logical,
and hypothetical manner, as well as the ability to
engage in metacognitions or the ability to reect
on their own thought processes. Erik Erikson
viewed adolescence from a psychosocial perspec-
tive and believed that the major task during ado-
lescence was the development of a cohesive sense
of identity. Erikson noted that one of the factors
that complicated this task for teenagers is their
rapid and dramatic physiological growth, particu-
larly surrounding puberty. From Eriksons per-
spective, the major task for adolescents was to
integrate the disparate aspects of the self into a
cohesive and integrated unit. Lawrence Kohlberg
viewed adolescence from the perspective of moral
development and noted that adolescents typically
struggle to behave in socially acceptable ways or
to be good during earlier periods of develop-
ment. Kohlberg believed that adolescents subse-
quent development entailed the ability to view
behavior more complexly from the perspective
of ones duty to the broader society. Thus, from
Kohlbergs perspective, adolescent behavior is
largely driven by the desire to avoid disapproval
from others, including feelings of guilt and shame.
Jane Lovinger viewed adolescence in a manner
similar to Kohlberg and postulated that the
pre-conformist and conformist stages of develop-
ment were most related to the adolescent devel-
opmental period. During pre-conformist
development, the adolescent operated in a largely
concrete and self-interested manner, generally
lacking empathy or sympathy for others and
avoiding inappropriate behaviors only when in
the presence of individuals or situations capable
of immediately punishing such behaviors. In con-
trast, Lovinger noted that most adolescents pro-
gress to the conformist stage of development
involved the ability to develop social skills and
group loyalties and the ability to view ones
behavior in terms of its consequences for other
individuals and to see the world from a less self-
centered perspective.
Because adolescents progress through these
complex developmental changes at dramatically
varying paces, much variability is found between
adolescents in terms of their maturational level.
This marked variability makes it quite challenging
to discriminate normal from abnormal functioning
with adolescents. Thus, for example, many nor-
mal adolescents endorse unusual or rare items on
the MMPI with a much higher frequency than
their adult counterparts. Adolescents, for exam-
ple, are much more likely than adults to endorse
MMPI-A and MMPI-A-RF items with a much
higher frequency than do their adult counterparts.
Illustrating this issue, the F or Infrequency Scale
on the original MMPI was substantially revised in
the creation of the MMPI-A and MMPI-A-RF,
because it was found that the endorsement fre-
quency of many of the items on the original
F Scale (descriptive of very unusual beliefs, atti-
tudes, or experiences) was much higher for ado-
lescents than for adults. Before leaving the
important issue of maturational inuences, it
might also be noted that the Immaturity (IMM)
Scale was developed for the MMPI-A to assess
psychological maturational issues based on Jane
Lovingers concept of ego development. The
IMM Scale was specically developed based on
her distinction between pre-conformist and con-
formist levels of functioning. The 43-item IMM
Scale consists of a variety of content areas includ-
ing lack of self-condence, externalization of
blame, lack of insight, interpersonal and social
discomfort, hostile and antisocial attitudes, and
self-centeredness and egocentricity. All of these
characteristics are associated with the
pre-conformist stage of development. Adoles-
cents who produce elevations on the IMM Scale
Minnesota Multiphasic Personality Inventory for Adolescents
are likely to be easily frustrated, loud and boister-
ous, and deant and resistant and to have a history
of academic and social difculties. In factor ana-
lyses done with the MMPI-A, it should also be
noted that maturation (or the converse of this
construct, i.e., immaturity) emerges as a major
factor dimension cutting across multiple MMPI-
A scales and accounting for a signicant amount
of variance in adolescents responses to this test
instrument.
Behavioral Problems Associated
with Adolescence
Several theories have pointed out that the behav-
ioral repertoire of adolescence increases dramati-
cally in relation to behavioral limitations shown
during early stages of childhood. The scope and
variety of new behaviors shown by adolescents
serve to mark their transition from childhood to
adulthood. While this new behavioral exibility is
generally positive, including development of
closer afliation with ones peer group and the
ability to more readily adapt to environmental
changes, other behaviors may become disruptive
and have adverse consequences both for the ado-
lescent and for the broader society.
Acting Out as a Primary Defense
Mechanism Among Adolescents
The US Ofce of Juvenile Justice and Delin-
quency Prevention has reported that roughly 1.7
million delinquency cases were handled by juve-
nile courts in 2005. Youths under age 16 account
for 57 % of these cases, minority youth account
for a disproportionately large number of all cases,
and females account for approximately 27 % of
all cases. Several studies have also shown that the
rate of psychiatric disturbance among adolescents
in the juvenile justice system is typically between
50 % and 60 % and that between one-half and
two-thirds of adolescents in detention or correc-
tional facilities would meet the criteria for one or
more psychiatric diagnoses, excluding conduct
disorder. These data support the belief that
5
externalization or acting out serves as a common
defense mechanism among adolescents and that
the distinction between adolescents in the mental
health and those placed in the juvenile justice
system is often ambiguous or arbitrary. Behav-
ioral problems and conduct-disordered behaviors
are the most common symptoms in both male and
female adolescents in psychiatric settings, and
these conduct-disordered behaviors often take
the form of aggression, property damage, lying,
theft, or serious rule violations. Delinquent and
criminal behaviors common among adolescents
typically reach their peak around age 18, with
the incidence and prevalence rates of offending
highest during late adolescence, and decreasing
after individuals reach the age of 30.
Pervasive MMPI, MMPI-A, and MMPI-A-RF
ndings support the importance of acting-out
behaviors as a primary defense mechanism
among adolescents. Over one-third of all adoles-
cents evaluated in mental health settings produce
an MMPI-A clinical basic scale prole that
involves the Psychopathic Deviancy Scale (Pd
Scale) as a primary scale elevation, and similar
ndings are found for the RC4 (Antisocial Behav-
ior) scale of the MMPI-A-RF. These data not only
illustrate the high rate of behavioral disorders
found among adolescents but also are consistent
with the observation that adolescents are quite
frequently referred for treatment because of their
conduct-disordered behaviors. Indeed, elevations
on the Pd Scale were found by Hathaway and
Monachesi, over 50 years ago, to be predictive
of delinquent outcomes, and elevations on the Pd
Scale (MMPI-A) or RC4 scale (MMPI-A-RF) are
the most common elevations found today among
adolescents in both psychiatric and juvenile jus-
tice settings (Archer 2016).
Stability of Personality Development
During Adolescence
Robert McCrae and Paul Costa have found in their
longitudinal studies that adolescents demonstrate
a signicant amount of change in personality
across the adolescent age span. They noted that
adolescents show marked changes in their
6 Minnesota Multiphasic Personality Inventory for Adolescents
appreciation of esthetics, their tolerance of alter-
native value systems, and their sensitivity to a
variety of moods and emotions. These authors
have concluded that personality structure does
not become stable until early adulthood. Other
researchers have also found that personality is
not stable during adolescence; for example, Rob-
erts et al. (2001) found that personality character-
istics are changeable and uid until the individual
reaches his or her middle-twenties, although some
particularly mature individuals appear to show
relatively stable personality congurations as
early as age 18.
Consistent with this view of personality insta-
bility during adolescence, the MMPI-A and
MMPI-A-RF are best conceptualized as adoles-
cent assessment tests that evaluate an adolescents
functioning at a particular moment in time. Sub-
stantial data shows that adolescents responses to
MMPI test items are subject to dramatic changes
over relatively short time intervals and that these
changes do not reect measurement error but
indicate actual changes in psychological function-
ing. Illustrating this point, Hathaway and
Monachesi (1963) reported three-year test/retest
correlation coefcients for the MMPI-A basic
scales that were generally quite low, ranging
from the mid .30s on scales such as Pd and Pa to
correlation values in the high .50s and low .60s for
the Social Introversion (Si) Scale. In general, sev-
eral studies have shown that the most stable ado-
lescent personality characteristics measured by
the MMPI appear to be the dimension of social
introversion/extroversion, but adolescent scores
on measures of affective distress, conduct disor-
der, and thought disorder appear to be highly
changeable across time. Commenting on the sub-
stantial changes shown by adolescents in their
three-year MMPI test/retest data, Hathaway and
Monachesi noted the transient organization of
personality during adolescence. Further illustrat-
ing this point, researchers used the MMPI data
collected from adolescents in the late 1940s and
early 1950s by Hathaway and Monachesi (1963)
to evaluate the proles of individuals who would
more than 20 years later be admitted to psychiatric
hospitals in Minnesota with a diagnosis of schizo-
phrenia. These researchers ultimately identied
183 men and women admitted to these public
psychiatric institutions who had also produced
MMPI proles in the original high school dataset,
26 of these eventually diagnosed as schizo-
phrenics. The MMPI proles of the 16 boys and
10 girls who would later manifest schizophrenia
were compared with their ninth-grade cohorts
without later histories of psychiatric diagnoses.
This remarkable study illustrated relatively lim-
ited differences between the two groups, and any
effort to predict schizophrenia from these adoles-
cents ninth-grade MMPI results would have been
of markedly limited value.
All of these ndings tend to underscore that
psychologists should use substantial caution in
attempting to make long-term predictions about
adolescents eventual functioning based on
MMPI-A or MMPI-A-RF ndings (or data from
any other source). This perspective resonates with
G. Stanley Halls view of adolescence as a period
marked by substantial emotional turbulence and
behavioral experimentation. This latter point was
also underscored in the perspective of Anna
Freud, who postulated that adolescence was a
period of development marked by substantial but
transient emotional upheavals.
Conclusions
The research literature on various forms of the
MMPI with adolescents across nearly 75 years
has resulted in the publication of several hundred
studies involving tens of thousands of adoles-
cents. This literature not only provides important
information concerning the operation of these test
instruments in the evaluation of the psychological
functioning of individual adolescent respondents
but also holds important implications for our
understanding of adolescent development and
psychopathology. These test results clearly under-
score the perspective that adolescence is a unique
period of development in which maturational
inuences have a profound effect on adolescents
emotions and behaviors and that adolescent devel-
opment is signicantly different from adult func-
tioning along many important dimensions.
Further, there is ample evidence that the use of
Minnesota Multiphasic Personality Inventory for Adolescents
acting out as a primary defense mechanism is a
ubiquitous occurrence among adolescents. Given
the uid nature of symptomatology often
displayed by adolescents, long-term predictions
based on MMPI or other psychological evaluation
ndings are often ill-advised, and discriminating
normal from abnormal functioning during adoles-
cence is a particularly challenging task.
References
Archer, R. P. (2005). MMPI-A: Assessing adolescent psy-
chopathology (3rd ed.). New York: Routledge.
Archer, R. P. (2016). Assessing adolescent psychopathol-
ogy: MMPI-A/MMPI-A-RF (4th ed.). New York:
Routledge.
Archer, R. P., Handel, R. H., Ben-Porath, Y. S., & Tellegen,
A. (2016). Minnesota Multiphasic Personality
View publication stats
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Inventory-Adolescent-Restructured Form (MMPI-A-
RF): Administration, scoring, interpretation, and tech-
nical manual. Minneapolis: University of Minnesota
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Butcher, J. N., Williams, C. L., Graham, J. R., Archer,
R. P., Tellegen, A., Ben-Porath, Y. S., et al. (1992).
MMPI-A (Minnesota Multiphasic Personality
Inventory-Adolescent): Manual for administration,
scoring and interpretation. Minneapolis: University
of Minnesota Press.
Hall, G. S. (1904). Adolescence: Its psychology and its
relations to physiology, anthropology, sociology, sex,
crime, religion and education. New York: Appleton.
Hathaway, S. R., & Monachesi, E. D. (1963). Adolescent
personality and behavior. Minneapolis: University of
Minnesota Press.
Roberts, B. W., Caspi, A., & Moftt, T. (2001). The kids
are alright: Growth and stability in personality devel-
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