Thursday, September 10, 2009

Dr. Tedd Judd guest comment post re: adaptive behavior and Switzky and Greenspan (2005) chapter

Guest comment post re: adaptive behavior by Dr. Tedd Judd, a neuropsychologist and current President of the Hispanic Neuropsychological Society.

Dr. Tedd Judd contacted the blogmaster via email as he had tried to post comments to the recent post re: the adaptive behavior chapter by Switzky and Greenspan, but the comment box was too limited for his complete set of comments. Posted below are Dr. Tedd Judd's comments ("as is") regarding the Switzky and Greenspan chapter post.

It is gratifying to see individuals reading and responding to the content of this blog. Thanks to all current and future readers. Active scholarly discourse is one of the goals of this blog.

Dr. Tedd Judd's comments below:

Very good chapter which addressed many pertinent issues well. I especially like the general principle of putting greater emphasis on adaptive functioning, even though the measuring of adaptive functioning is and will likely continue to be more problematic than IQ testing. For too long we have been looking for the keys under the street lamp where the light is good instead of over in the dark where we dropped them.

I also like the emphasis on refining what we really mean by adaptive functioning. The available adaptive behavior scales, in my reading of them, not only fail to measure gullibility adequately, that actually seem to reward it by giving higher ratings to compliant behavior (something that, for me, reflects the nicey nice world of MR services). There are more details in my chapter except below.

I take a bit of exception with this chapter placing gullibility so centrally, however. Some people with MR are not very nice or compliant or gullible, but may be somewhat paranoid, egocentric, and angry, although perhaps for reasons of faulty thinking that are similar to the faulty thinking of those who are gullible. Those individuals may look much more like someone with an antisocial personality disorder (they may even be diagnosable with ASP), but with a cognitive deficit underlying that disorder. It seems to me that it is for just such individuals that the SCOTUS included in their reasons for the Atkins decision that for people with MR "their demeanor may create an unwarranted impression of lack of remorse for their crimes." So, while social skills deficits need greater elaboration and emphasis, they can take various forms.

I am hopeful that readers who have stuck with me thus far may be willing to pursue some discussion of related points from my chapter section below from

Adaptive Behavior Scales

Adaptive behavior rating scales are not tests of abilities. The focus person and/or an informant who knows that person well rate the person on the ability to carry out various everyday activities. These scales are particularly important in the diagnosis of mental retardation because the accepted definitions of mental retardation (American Association on Mental Retardation, 2002; American Psychiatric Association, 1994) require impairment not only on IQ testing but also in adaptive behavior. Such scales are typically normed by age on a nationally representative sample (Scales of Independent Behavior—Revised, Bruininks, Woodcock, Weatherman, & Hill, 1996; Adaptive Behavior Assessment System, Harrison & Oakland, 2000; AAMR Adaptive Behavior Scale, Nihira, Leland, & Lambert, 1993; Vineland Adaptive Behavior Scale, Sparrow, Balla, & Cicchetti, 1985). These scales typically do not have validity scales to determine if there is response bias on the part of the rater. The cultural competence to complete the rating scales and potential biases of the informant must be taken into account.

Adaptive behavior is clearly culturally relative, and this is evident in the rating scales. For example, the referenced scales contain items referring to the use of telephones, microwaves, small electrical appliances, clothes washers and dryers, repair services, cars, seatbelts, air conditioners, thermometers, handkerchiefs, televisions, menus, dictionaries, alphabetizing, phone books, zip codes, bathroom cleaning supplies, electricity, scales, rulers, schedules, Christmas, Hanukah, forks, reading materials, ticket reservations, shoelaces, clocks, classified ads, and checkbooks. Access to these items is not universal and is related to culture, urbanization, and social class. There are no items referring to clotheslines, chopsticks, domestic animals, Ramadan, etc.

Other items depend upon cultural norms of behavior or values that are not universal (looking at others’ faces when talking, ending conversations, not interrupting, carrying identification, traveling independently in the community, stores with hours of operation, obeying street signs, needing time alone, choosing to join group activities, haircuts, daily bathing, punctuality, hospitality, controlling temper, “pleasant breath,” saying “thank you,” conversational distance, dating, etc.). Although several of these scales have been translated into Spanish (and possibly other languages) there has been minimal cultural adaptation of the items, and there are minimal instructions in the manuals concerning cross-cultural applications.

Some items imply that it is more functional to be compliant than to stand up for oneself. These items include: controlling anger when someone else breaks the rules, when an activity is cancelled, when disagreeing with friends, or when not getting one’s way; not telling a lie to escape punishment; saying “thank you” for gifts (something that is not a part of many Native American cultures); moving out of another person’s way; offering assistance and sympathy; selecting “good” friends; avoiding embarrassing others; doing extra work willingly; and following supervisor’s suggestions. There are no items giving credit for knowing: when and how to direct one’s anger, when it is wise to lie, when to offer assistance and sympathy and when not, when to use one’s own judgment and when to follow others’ in selecting friends, when it is appropriate to embarrass others, when it makes sense to do extra work or follow the supervisor and when to object or go on strike, etc. There are no items saying, “Asserts ones rights.” Or “Stands up for others who are treated unjustly.” It is sobering to realize that people might be declared legally stupid for having bad breath, not telling jokes, not making their beds, or not buying tickets in advance.

Adaptive behavior scales can play an important role in cross-cultural neuropsychology. At times they may help document that an individual who does not “test well” on standardized cognitive tests, perhaps for cultural reasons, nevertheless is able to function adequately and competently in this society. Adaptive behavior scales in brain injury cases can document the changes in a way that cognitive tests cannot. However, interpretation of low scores is problematic because the scales are culture bound. In some instances the adaptive behavior scale may function more as a measure of acculturation than of ability. At present such interpretations may require an item-by-item analysis of low scored items, perhaps including a discussion of those items with the rater and/or other cultural informant. In spite of their cultural limitations, however, these standardized scales have advantages over the evaluation of adaptive behavior exclusively by interview. They are more thorough than typical interviews, they allow for objective comparisons to known populations, and they allow for greater clarity regarding the database for opinions and decisions. They do not, however, replace the evaluation of adaptive behavior via interview, since interviews are likely to bring out the most pertinent impairments in adaptive behavior and may cover areas not found in the scales.

Technorati Tags: , , , , , , , , , , , , , , ,