What is ‘clinically relevant behavior’: Sign or sample

As discussed by Ollendick et al. (2004), abnormal and clinically-relevant behavior can be viewed as either a “sample” or as a “sign.” To what extent does this difference, in turn, make a difference in the assumed temporal and situational consistency of such behavior?

Whether you view abnormal and clinically-relevant behavior as a “sample” or a “sign” makes a significant difference in whether you consider such behavior to be consistent over time and in various situations. If a behavior is seen as only a “sample” of a person’s behavior then there is no expectation that this behavior will be consistent over time or in different situations. When behavior is only said to be only a “sample” the implication is that you expect variation in the behavior. If the behavior is thought of as a “sign”, however, the implication is that the behavior is only an indication of an underlying trait or pathology which implies that the behavior should be more constant through time and situations. From this view as long as the underlying pathology, trait, etc. is present then behavioral “signs” of the underlying construct should also be present. In the relation to psychological problems this “sign” conceptualization, however, is most often a circular or reifying argument. A “sign” behavior indicates a “disorder” when a “disorder” only indicates a collection of symptoms. This conceptualization provides no particular “cause” for the behavior other than itself. This conceptualization is an artifact of using the methods of physicians to understand physical disease to understand human behavior.

The understanding of behavior as a “sample” vs a “sign” also impacts how problem behavior is conceptualized and in turn how assessment is conducted. If the behavior is only a “sample” of a person’s behavior at a certain time in a certain situation than an assessment of the person’s behavior in other situations is likely to be important. If the behavior is a “sign” then assessment over one time period in one situation is more acceptable because the behavior is assumed to be stable as long the “disorder” is constant. Assessment of “sample” behavior may also involve a less predetermined route than assessment of “sign” behavior. As behavior seen as a “sample” implies that there may be a wide variety of other problem behaviors that may exist with the target behavior. Thus, assessment may include any route of questioning, observing etc. that helps the clinician learn about all problem behavior and any possible relationships between the environment and problem behaviors. Because the behavior is expected to vary by situation, factors related to the situation may more likely be considered part of the conceptualization of the problem and should be assessed. If behavior is conceptualized as an “sign”, however, the behavior is related to internal factors and assessment is more likely to focus on assessing for other problem behaviors that are understood to cluster to indicate the underlying pathology. Assessment of environmental/situational factors is also less important if the behavior is understood to indicate pathology as the person’s behavior should continue to indicate the pathology across situations. In other words, assessment from a “sample” behavior perspective is more likely to be all-inclusive in assessing what other behaviors are present and what factors may be causing the problem behavior. Assessment from behavior as a “sign” perspective is more likely to be limiting in the sense that the clinician begins by looking specifically for behaviors that indicate a disorder and is more likely to ignore situational factors in the behavior and understand the “disorder” indicated the cause of the problem behavior.