Thursday, December 31, 2009

Adapitve behavior "best practices" in Atkins MR/ID cases: Tasse (2009)

The ongoing critical issue poll on the ICDP  blog sidebar has made it clear that readers want more information regarding the nature and measurement of the construct of adaptive behavior.  Although the assessment and definition of adaptive behavior has progressed over the past decades, it is not enjoyed the lengthy history of research that has resulted in current intelligence testing technology. That being said, I'm going to attempt to make more posts related to adaptive behavior in the context of Atkins cases. These posts will be based primarily on my reading of professional journal articles or book chapters written by authorities in the field.   As always, I'm extend an open invitation to individuals with expertise in adaptive behavior to submit guest blog posts in this area.

I selected this article because I agree with most of what  Dr. Tassé suggests and recommends.

  • Tassé, M. J.  Adaptive Behavior Assessment and the Diagnosis of Mental Retardation in Capital Cases.  Online Publication Date: 01 April 2009 . To cite this Article Tassé, Marc J.(2009)'Adaptive Behavior Assessment and the Diagnosis of Mental Retardation in Capital Cases',Applied Neuropsychology,16:2,114 — 123 To link to this Article: DOI: 10.1080/09084280902864451 URL:
Highlights from article

(unless otherwise specified via italics or underlying, the following text are direct extractions from the article. Any comments by the blog master are designated by italics or underlining.)

  • According to the author, the primary adaptive behavior issues in Atkins cases are: Issues related to standardized assessment instruments, self-report, selection of respondents, use of collateral information, malingering, and clinical judgment are discussed.
  • Adaptive behavior is defined as the collection of conceptual, social, and practical skills that have been learned by people to function in their everyday lives
  • Standard definitions of mental retardation indicates that there must be:  deficits in both intellectual functioning and adaptive behavior, and these deficits must have originated during the developmental period. It should be noted that ‘‘originated during the developmental period’’ does not preclude making a first time diagnosis of mental retardation when an individual is an adult. The clinician must, however, adequately document that the deficits in intellectual and adaptive functioning were present before the end of the developmental period.
  • A major distinction between adaptive behavior and intellectual assessment is typical versus maximal performance. This is a long-standing classic distinction first articulated by Cronbach.  This view is consistent with AAIDD’s long standing position that adaptive behavior assessment must focus on the individual’s typical performance and not maximal ability (see Luckasson et al., 2002).  Thompson, McGrew, Bruininks (2002) discuss this distinction in the context of MR/ID, personal competence, and adaptive behavior. The figure below, which highlights the typical versus maximal performance distinction (within the context of Greenspan's model of personal competence), was extracted from that Thompson et al. article and can be viewed by clicking here.
[Double click on the image to enlarge and make more readable]

  • Luckasson et al. also emphasized the importance of using standardized adaptive measures that had been normed on the general population and assessed the broad array of adaptive behavior, including conceptual, practical, and social skills.  Note--the inappropriate use of adaptive behavior measures that have not been normed on the general population (e.g., SSSQ), when used in the context of Atkins cases, was the topic of  two prior posts.
  • The use of a standardized adaptive behavior scale is often insufficient to capture all aspects of an individual’s adaptive behavior. Elements of adaptive behavior that are related to adult social adaptive skills or higher order interpersonal skills are lacking from most existing adaptive behavior scales
  • Greenspan (Greenspan, 1981; Greenspan, 2006; Greenspan, 2008; Greenspan, Loughlin, & Black, 2001; Greenspan & Switzky, 2006) has devoted much of his career to studying and publishing on concepts that are often present in individuals with mild mental retardation, but under-represented in standardized adaptive behavior scales: social competence, gullibility, naivety, and lack of wariness
  • Anyone conducting an adaptive behavior assessment is strongly encouraged to consult the chapter by Harrison and Raineri (2008) on the Best Practices in the Assessment of Adaptive Behavior. [Harrison, P. L., & Raineri, G. (2008). Best practices in the assessment of adaptive behavior. In A. Thomas & J. Grimes (Eds.), Best practices in school psychology (5th ed.) (pp. 605–616). Bethesda, MD: NASP Press.]
  • Two of the more challenging aspects of any adaptive behavior assessment of an individual who is incarcerated include: the assessment of the individual’s present functioning and the assessment of the individual’s typical behavior in meeting community demands and expectations.
  • Thus, assessment of adaptive behavior for the purpose of making a diagnosis of mental retardation involves assessing the individual’s present, typical behavior. as well as the individual’s functioning as it occurs in the community. It is not a measure of capacity or knowledge, but in fact is a measure of what the individual typically does and what is the degree of independence in performing these skills
  • Stevens and Price (2006) recommended that future research in the area of adaptive behavior assessment should develop norms on prison populations. This author strongly disagrees with this notion. Norming an adaptive behavior scale on people living in prisons would have as much value as norming a new IQ test on people living in prisons.  Note--the blog master strongly agrees with this position.
The authors discuss the important concept of using convergent information
  • There exists no one standardized adaptive behavior scale that captures the entire spectrum of adaptive behavior across all age groups (Luckasson et al., 2002; Thompson, McGrew, & Bruininks, 1999). This does not, however, negate the importance of using such measures when possible. Rather, any comprehensive evaluation of adaptive behavior should seek to corroborate information obtained on standardized measures from sources such as: school records, employment history, social security administration records, medical records, and interviews with respondents who know the individual well but who might not be able to provide comprehensive information sufficient to complete all domains on an adaptive behavior scale. In addition to the use of standardized measures of adaptive behavior, it is crucial to obtaining corroborating information from other sources. For example, the individual’s school records can provide a wealth of information regarding conceptual, practical, and social skills. It will be necessary to also consult social security administration records, driving record, employment history, medical records, and social and family history. In addition to interviewing individuals to complete a standardized adaptive behavior scale, it is vital to conduct clinical interviews of relatives, friends, teachers, coaches, employers, roommates, etc. in order to obtain some qualitative information regarding the individual’s adaptive behavior. This information can be crucial in providing corroborating information regarding areas of limitations and strengths.
Administration of standardized behavior scales and completing semi-structured interviews
  • The ideal respondents are individuals who have the most knowledge of the individual’s everyday functioning across settings. Typically, the individual’s parents or caregivers are the persons with the most opportunity to observe the assessed individual in his=her everyday functioning. As the individual becomes an adult, this role may shift to a spouse or roommate. Other individuals who may provide valuable adaptive behavior information include: older siblings, grandparents, aunts=uncles, neighbors, teachers, coaches, employers, coworkers, friends, or other adults who may have had multiple opportunities over an extended period of time to observe the individual in his everyday functioning in one or more contexts (e.g., home, leisure, school, work, community).
  • Correctional officers and other prison personnel should probably never be sought as respondents to provide information regarding the adaptive behavior of an individual that they’ve observed in a prison setting.

The critical issue of retrospective assessment
  • A retrospective assessment of adaptive behavior is often considered as the only viable option when the assessed individual is incarcerated. Interviewing a respondent while asking them to recall a time prior to the individual’s incarceration is the proposed means of capturing the individual’s typical adaptive behavior in the community and establishing a retrospective diagnosis (Schalock et al., 2007). It should be noted that there is no research available examining the reliability or error rate of adaptive behavior assessments obtained retrospectively. At issue is the respondent’s ability to correctly recall from memory the assessed individual’s actual performance. Memory degradation is a real issue and we do not have any solid research regarding (Memon & Henderson, 2002) recollection of another person’s adaptive behavior.
  • To assist the clinician with this difficult task, Schalock et al. (2007) recommended specific guidelines to follow when making a retrospective diagnosis of mental retardation, including using multiple respondents and multiple contexts and assessing adaptive functioning within the general community and within the individual’s
The issue of clinical judgment
  • Professionals should always use clinical judgment throughout the process of making or ruling out a diagnosis of mental retardation. One uses their clinical judgment in selecting an appropriate adaptive behavior assessment instrument, identifying who to interview as a respondent, assessing the respondent’s reliability, identifying and reviewing available records, and analyzing and interpreting all the available information to form an opinion.
  • Schalock and Luckasson (2005) defined clinical judgment as being founded upon clinical expertise in a particular area and that clinical judgment is based upon a thorough analysis of extensive data. Equally important, these authors state that, ‘‘Clinical judgment should not be thought of as a justification for abbreviated evaluations, a vehicle for stereotypes or prejudices, a substitute for insufficiently explored questions, an excuse for incomplete or missing data, or a way to solve political problems’’ (p. 6). Hence, clinical judgment should not be used as a shield when one draws conclusions that are not supported by the assessment results, observations, and=or case records.
Authors concluding comments
  • Most individuals with mental retardation will have strengths and areas of ability (see Luckasson et al., 2002). These strengths may confound a layperson or a professional with limited clinical experience with individuals who have mild mental retardation.
  • Mental retardation is a clinical diagnosis that should be made or ruled out based on a rigorous and comprehensive professional evaluation of the individual’s intellectual functioning and adaptive behavior. If there is a presence of significant deficits, there must be an ascertainment that these deficits were manifest prior to age 18. A person who has been appropriately diagnosed with mental retardation should be identified as having mental retardation regardless of the individual’s living arrangement, accommodations, or supports in place that could very well result in better functioning.
  • When we assess adaptive behavior for the purpose of making or ruling out a diagnosis of mental retardation, the use of standardized adaptive behavior scales is often central since they provide an objective metric with which to determine whether or not the individual’s limitations are significantly below the average of the general population. The information obtained from standardized adaptive behavior scales should be corroborated with information from other sources, such as interviews with other informants and a thorough review of records and previous evaluations.
  • Assessment of adaptive behavior needs to be conducted using a combination of standardized adaptive behavior scales, adaptive behavior interviews of multiple informants who have observed the individual in different contexts, and a review of all available records. The standardized instrument is not error-free. The results obtained on a standardized adaptive behavior scale must be interpreted in relation to the instrument’s reliability and resulting standard error of measurement.
  • Self-ratings on standardized adaptive behavior scales are fraught with potential problems and should be interpreted with caution.
  • Retrospective adaptive behavior assessments should be well-documented with respect to respondents interviewed, procedure used, assessed time-frame (e.g., when individual was 17 years old), normative group used to interpret results, and source of convergent information that corroborates or contradicts results obtained. As with any type of adaptive behavior assessment, multiple respondents should be used and these respondents should preferably have had the opportunity to observe the assessed individual in different contexts. Results from a retrospective evaluation should be interpreted with caution.
  • Making a diagnosis of mental retardation is not like baking a cake, where one opens a book, follows the in order to meet societal settings (Luckasson et al., prescribed instructions, and out comes the certainty of whether or not a diagnosis such as mental retardation exists. Making a diagnosis of mild mental retardation is one of the more challenging diagnoses to make (Schalock et al., 2007). Most forensic psychologists have broad clinical training as well as training and experience to work with the courts and criminal defendants. Mental retardation professionals often have training and experience in working with individuals with and without mental retardation, but lack the training regarding the forensic science. The Atkins Supreme Court decision has resulted in the bridging of two fields: forensic psychology and the interdisciplinary field of mental retardation. Perhaps it is time to answer Everington and Olley’s (2008) call for forensic and mental retardation professionals to join forces and provide leadership in developing practice of mental retardation proposed practice guidelines should build upon an established national standard for diagnosing mental retardation (such as the AAIDD system), or else we risk creating a clinical diagnosis and a forensic diagnosis of mental retardation. guidelines for in the forensic the diagnosis setting.
Technorati Tags: , , , , , , , , , , , , , , , , , , ,