ASWB Clinical Assessment 5 — Questions and Answers
Question 1: A social worker is assessing attachment patterns in a young child using observational methods. Which behavior MOST strongly indicates a disorganized attachment pattern?
- Crying briefly at separation, quickly comforted on reunion
- Ignoring the caregiver upon reunion after brief separation
- Approaching the caregiver with fearful or contradictory behaviors upon reunion (Correct answer)
- Showing separation distress but being difficult to soothe
Correct answer: Approaching the caregiver with fearful or contradictory behaviors upon reunion
Disorganized attachment is characterized by contradictory, fearful, or disoriented behaviors toward the caregiver who is simultaneously the source of fear.
Question 2: During a psychosocial assessment, a client reports that she began binge-eating and purging at age 15 but has used restriction alone for the past two years without bingeing. How should the social worker classify the current presentation?
- Bulimia Nervosa, currently in remission
- Anorexia Nervosa, restricting type, with history of Bulimia Nervosa (Correct answer)
- Binge Eating Disorder in partial remission
- Other Specified Feeding or Eating Disorder (OSFED)
Correct answer: Anorexia Nervosa, restricting type, with history of Bulimia Nervosa
If the client currently meets AN criteria through restriction only, the correct diagnosis is Anorexia Nervosa, Restricting Type, with past Bulimia Nervosa noted in the clinical history.
Question 3: A social worker assessing a client for Borderline Personality Disorder should use which time frame for symptom evaluation?
- Symptoms present only during a current depressive episode
- A pervasive pattern present since early adulthood across multiple contexts (Correct answer)
- Symptoms lasting at least two weeks
- Symptoms triggered exclusively by identifiable stressors
Correct answer: A pervasive pattern present since early adulthood across multiple contexts
Personality disorder diagnoses require a pervasive, enduring pattern that began in adolescence or early adulthood and is not limited to mood episodes or situational reactions.
Question 4: A social worker uses the PHQ-9 with a new client. A score of 15 indicates:
- Minimal depressive symptoms requiring no intervention
- Moderately severe depression warranting active treatment planning (Correct answer)
- Severe anxiety requiring immediate psychiatric hospitalization
- A screen positive for alcohol use disorder
Correct answer: Moderately severe depression warranting active treatment planning
A PHQ-9 score of 15–19 indicates moderately severe depression, which typically warrants active treatment such as psychotherapy, pharmacotherapy, or both.
Question 5: A social worker is conducting a lethality assessment after a client discloses a plan to overdose on stockpiled medication. Which factor MOST increases imminent risk?
- The client has a supportive spouse at home
- The client has access to the lethal means described in the plan (Correct answer)
- The client has a history of treatment engagement
- The client called the social worker voluntarily
Correct answer: The client has access to the lethal means described in the plan
Access to the specific means in the plan dramatically increases imminent risk; means restriction is a first-line safety intervention precisely because access is a key risk amplifier.
Question 6: A social worker assesses a client who reports believing that TV news anchors are sending coded messages specifically intended for him. This belief is BEST described as:
- An auditory hallucination
- A delusion of reference (Correct answer)
- A persecutory delusion
- Magical thinking within normal limits
Correct answer: A delusion of reference
A delusion of reference is a fixed false belief that neutral external events carry a special, personal significance directed at the individual.
Question 7: When a social worker documents that a client's affect was 'constricted,' this means:
- The client was crying throughout the session
- The client's emotional expression was reduced in range but not entirely absent (Correct answer)
- The client showed rapidly shifting emotional states
- The client's reported emotion did not match visible expression
Correct answer: The client's emotional expression was reduced in range but not entirely absent
Constricted affect refers to a narrowed range of emotional expression — less than the typical range but not the complete absence seen in flat affect.
ASWB Clinical Assessment 5
A social worker is assessing attachment patterns in a young child using observational methods.
Which behavior MOST strongly indicates a disorganized attachment pattern?