New directions in neuropsychological assessment: Augmenting neuropsychological assessment with CHC cognitive measures

I just returned from Australia where I made a number of presentations.  Two were at the 2010 16th Annual APS College of Clinical Neuropsychologists Conference. 

I just posted the slides (at my SlideShare site - click here) from my 2+ hour workshop:  New directions in neuropsychological assessment: Augmenting neuropsychological assessment with CHC cognitive measures.

Briefly, the workshop is my first attempt to integrate CHC with neuropsychological assessment, with an emphasis on how NP tests can be interpreted from the CHC intelligence model which can then serves as a foundation for follow-up testing of NP tests with CHC measures.  Below are a few "tease" slides to get readers interested.  The last slide is derived from the keynote presentation I made (Beyond CHC theory...), which will be posted shortly.

Technorati Tags: Psychology, school psychology, developmental psychology, educational psychology, forensic psychology, neuropsychology, special education, intelligence, cognitive abilities, cognition, intelligence theories, CHC theory, CHC, Cattell-Horn-Carroll, intelligence, cognition, IQ, IQ tests

Dr. Tedd Judd comments on Arbaleaz v Florida (2010) decision: Guest blog comment

Dr. Tedd Judd sent me the following comments re: the recent posting of the Arbaleaz v Florida case.  His comments were too long for the blog post comment feature.  His comments are reproduced "as is"

Dr. Judd states:

This case raises a host of issues. In this comment I would like to mention several and then discuss one, measuring adaptive behavior, in more depth.

1.       Should U.S. norms for IQ and/or adaptive behavior be used since that is the population they are being judged against and the context of the Atkins decision? Or should we use national norms from the nation of origin or some other subpopulation norms? Or national norms for childhood and U.S. norms for current?

2.       MR is not necessarily lifelong. Which time period is relevant? Childhood is relevant by definition. Time of the crime? Time of trial? Time of execution? (The reasoning behind various Atkins decisions suggests to me that all 4 of these time periods are pertinent, so perhaps Atkins evaluations should address all 4 distinctly.)

3.       Clinically measuring adaptive behavior in prison and using prison guards is problematic and prone to misinterpretation by the court but should not be entirely ruled out, since such behavior can be pertinent. Just by way of example, if a defendant earned a college degree while in prison it would not be intellectually honest to say that that was irrelevant.

4.       Potential bias in rating adaptive behavior (whether by self, family members, friends, teachers, prison guards, etc.) is problematic not only for Atkins but also when mitigation or access to services and disability accommodations and payments may be at stake. For this reason, validity scales in future versions of adaptive behavior scales would be useful. How to devise such scales is tricky, but I have some suggestions to offer here:

a.       Items that are very similar to one another could be included and compared for consistency of response, as is done in the PAI, BRIEF and others. This would address accuracy of comprehension, etc. but not systematic bias.

b.      Instead of presenting items in order of increasing difficulty by category, as the ABAS and Vineland do, they could be mixed, as in most personality inventories. Then a computer analysis may be able to discriminate if responses regarding the easy versus hard activities show consistency. I believe that a similar strategy is used in the VIP malingering test.

c.       The rating scale could be linked to a performance scale concerning selected items on the rating scale. For example, there might be an item, “Is able to read a telephone number of 10 digits and dial it accurately.” This ability could then be tested directly. A few such measures might be unobtrusive, such as filling out their name and address and other information on the rating form and following certain written directions on the form. Norms could be developed regarding how closely performance matches rating and significant deviations might suggest invalid ratings. While an individual might still malinger on both rating and performance, they might not do so consistently. Such a matching could potentially pick up both overly negative and overly positive rating sets and may be particularly useful with respect to the validity of informant ratings.

d.      With respect to cultural bias, peer comparisons might be used instead of more absolute ability norms. In other words, items might be constructed as follows: “Compared to others his/her age, his/her ability to ____________ is: Much better, somewhat better, about the same (or average), somewhat worse, much worse.” A similar approach has been used with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) in which the person rated is compared to themselves 10 years earlier on various everyday memory and executive abilities. The IQCODE has been found to be sensitive to dementia and insensitive to effects of culture and education.



Tedd Judd, PhD, ABPP-CN

Cross-Cultural Neuropsychologist

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Atkins MR death penalty experts: Knowledge and exerience required (Olley, 2009)

What does it take to be an expert in Atkins MR death penalty cases? A good article outlining a number of the skills, knowledge, issues and expertise required is that by Olley (2009) in the special issue of the journal Applied Neuropsycholgy. Individuals considering testifying in Atkins MR death penalty cases should read this article in full.

• Olley, J. G. 2009. Knowledge and Experience Required for Experts in Atkins Cases. Applied Neuropsychology,16 (2), 135-140.

Abstract

The United States Supreme Court’s Atkins v. Virginia (2002) decision has created a need for experts who are knowledgeable and experienced in both mental retardation and forensic psychology. This article summarizes the issues that are critical to the diagnosis in the ‘‘close calls’’ that typify Atkins cases. A resolution of such close calls hinges upon the expert’s ability to testify with regard to the characteristics of mild mental retardation and the way that diagnostic standards may be applied differently in clinical versus forensic settings. The critical impairments are not in the form of physical stigmata. They are characterized by difficulties in judgment when engaged in typical community functioning. The keys to these close calls are the individual’s problems in functioning in the community with the degree of independence required for adults.

ARTICLE SUMMARY

[note: Italics are direct quotes. Underline is emphasis added by the blogmaster]

According to the articles author:

Those who have been testifying in Atkins hearings have come from varied professional backgrounds. The knowledge and expertise needed for "expert testimony in Atkins involve an unusual mix of background in the field of developmental disabilities with a background in forensic psychology. This combination of credentials was rare before the Atkins decision, and, thus, psychologists and other experts who are asked to testify may have limited experience in some of the essential aspects of the diagnosis of mental retardation in this new context."

Forensic psychologists are most likely to be recognized and accepted by the courts as experts, but the majority of forensic psychologists have little training or experience in the field of developmental disabilites (mental retardation).

Given the lack of uniform training, the author suggests the following as key issues that Atkins experts need to be familiar with:

• Relevant professional standards (note--see Standards, Ethics and Position Statements" links in current blogs sidebar (right side of blog)
  

• Current definitions of mental retardation, and the recognition that different states may have different definitions and diagnostic criteria.

• Relevant ethical principles of their profession "(American Academy of Psychiatry and the Law, 2005; American Psychological Association, 2002), position statements made by professional organizations (e.g., American Bar Association Task Force on Mental Disability and the Death Penalty, 2006; Bonnie, 2004; Committee on the Revision of the Specialty Guidelines for Forensic Psychology, 2008), and recommendations made by recognized authorities in the field (e.g., Bonnie & Gustafson, 2007; Ellis, 2003)."

• Understand a key difference between clinical and forensic settings. In clinical settings, typically definitions and criteria are used to identify individuals "who meet the criteria and would benefit from services and supports." In such situations professional standards allow psychologists to excercise clinical judgment and to take into consideration the potential benefits of services for the assesed invididual. In contrast, the most significant issues in court settings are likely to focus more on the application of professional definitions in a more narrowly circumscribed and constrained legal context.
  

The author notes that "most Atkins cases are close calls; that is, evidence exists for and against the diagnosis, and if the defendant has mental retardation, it is in the mild range with functioning between two and three standard deviations below the population mean." The author then lists a number of important issues that must be recognized in these "close calls." They include, but are not limited to:

Impairment in Typical Community Functioning. This is not an easy task an involves a variety of issues, including:

• Understanding that mild MR is primarily identified by impaired typical community functioning and not specific diagnostic signs or physical symptoms. The cause of mild MR is typically unnkown.

• Typical functioning is difficulty to assess given that the person is incarcerated in a structured environment and collecting pre-incarceration information re: typical commmunity functioning requires significant effort.

• An individuals typical functioning must be compared to the normative standards of the appropriate population (US population...not a prison population)

• Recognition that mild MR may coexist with other disorders or diagnoses.

• Self report information from the defendant "is of very questionable value in the diagnosis of mental retardation. The expert in an Atkins proceeding should, of course, meet with the defendant, interview him, and engage him in whatever activities might help to determine his understanding of his current situation, his ability to report on factual aspects of his history, and his ability to relate to others. However, the defendant’s assessment of his own functioning is not a valid source of data on which to form a diagnosis. Most people with mild mental retardation can engage in casual conversation and report on their experiences and other concrete topics. Limitations in understanding and communication become evident when the individual is asked to explain his statements or to discuss topics that require abstract reasoning or analysis."

• "the extent to which the individual was able to live independently with minimal assistance is key to the diagnosis of mental retardation in close calls."

• individuals with mild MR rarely have social relationshiops that are mutually beneficial and reciprocal. "In most cases, the individual has few friends and the existing relationships tend to be one-sided. That is, the individual depends on a parent or girlfriend or neighbor as a ‘benefactor’ or has acquaintances who try to exploit him for money, labor, drugs, or other resources."

Significant Impairment in General Intelligence. Select issues to recognize include:

• A cause-and-effect relationship betwen intelligence (IQ) and adaptive functioning is difficult to prove

• Atkins defendents typically have taken multiple IQ tests and the scores often fluctuate around the legal cut-off score. Experts need to recognize the potential reasons for this IQ variability and account for it in their interpretation and conclusions.

Training Issues in Forensic Psychology

• States and jurisdictions may specify different standards regarding who can testify as an expert in Atkins cases. Experts need to be aware of the professional standards involved in a specific case before deciding to serve as an expert witness.

• "psychologists preparing to testify in Atkins proceedings would benefit by becoming members of two divisions of the American Psychological Association. Division 33 (Intellectual and Developmental Disabilities) and Division 41 (American Psychology-Law Society) often provide information relevant to Atkins and offer the opportunity to become acquainted with colleagues with experience in this area."

Article summary

The expert in an Atkins proceeding must have experience with individuals with mild mental retardation, knowledge of the research on this population, and knowledge of the applicable laws and court procedures. This combination of knowledge and experience was rare before the Atkins decision, and experts who now work in this area must broaden their experiences to provide the most valid and objective information to the court. As the other articles in this issue have demonstrated, the diagnosis of mild mental retardation is complex and requires more than the rigid application of test scores. People with mild mental retardation may have basic academic skills and several areas of adequate community functioning. Their difficulties that set them apart are more likely located in their judgment than in their knowledge and skills. Reschly (2009, this issue) provides an excellent summary in noting that ‘‘The core issue is the use of abstract reasoning and judgment in coping with everyday demands in a socially and economically complex society.’’

Use of the Mexican WAIS-III in MR capital Atkin cases: Controversy reported in Applied Neuropsychology journal

Is the Mexican normed version of the WAIS-III appropriate for use in diagnosing mental retardation and, more importantly, is it appropriate for use in Atkins MR death penalty cases? Apparently a controversy has surfaced re: this question as reflected by three articles in the journal Applied Neuropsychology.

As background note, I've blogged previously about a special issue of this journal that dealt with Atkins cases. I've not completed reading all of those articles yet...there simply is not enough time in my day.

Given my obvious conflict of interest [I'm a coauthor of the competing WJ III and BAT III], I will not render any judgment "pro" or "con" regarding the debate. Instead, I'm making available (below) the abstract of a series of three articles published in the latest issue of Applied Neuropsychology that address the issue. Suen and Greenspan (2009a) make the case against the use of the Mexican WAIS-III. Escobedo and Hollingworth (2009) respond to Suen and Greenspan (2009a). Suen and Greenspan (2009b) then respond to Escobedo and Hollingworth (2009).

Readers will need to review the articles and make their own informed judgments. I would like to invite appropriatelly qualified scholars to consider submitting a guest comment post on all three articles and any other journal published research that bears on this specific controversy. If interested, contact me at my email in my "About Me" section of this blog. In addition, given my conflict of interest, I am requesting that anyone familiar with any similar controversies or questions regarding the BAT III to bring them to my attention as I would make those published articles available for review...also without comment.

Suen, H. K. & Greenspan, S. (2009a). Serious Problems with the Mexican Norms for the WAIS-III when Assessing Mental Retardation in Capital Cases. Applied Neuropsychology, 16 (3), 214-222. (click here).

A Spanish-language translation of the Wechsler Adult Intelligence Scale-III (WAIS-III), normed in Mexico, is sometimes used when evaluating Spanish-speaking defendants in capital cases in order to diagnose possible mental retardation (MR). Although the manual for the Mexican test suggests use of the U.S. norms when diagnosing MR, the Mexican norms—which produce full-scale scores on average 12 points higher— are sometimes used for reasons that are similar to those used by proponents for ‘‘race-norming’’ in special education. Such an argument assumes, however, that the Mexican WAIS-III norms are valid. In this paper, we examined the validity of the Mexican WAIS-III norms and found six very serious problems with those norms: (1) extremely poor reliability, (2) lack of a meaningful reference population, (3) lack of score normalization, (4) exclusion of certain groups from the standardization sample,(5) use of incorrect statistics and calculations, and (6) incorrect application of the true score confidence interval method. An additional problem is the apparent absence of any social policy consensus within Mexico as to the definition and boundary parameters of MR. Taken together, these concerns lead one to the inescapable conclusion that the Mexican WAIS-III norms are not interpretable and should not be used for any high-stakes purpose, especially one as serious as whether a defendant should qualify for exemption against imposition of the death penalty.

Escobedo, P. S. & Hollingworth, L. (2009) Annotations on the Use of the Mexican Norms for the WAIS-III. Applied Neuropsychology, 16 (3), 223-227 (click here).

This article provides crucial information to judge the appropriateness of the Mexican version of the Wechsler Adult Intelligence Scale-Third Edition and recognizes some limitations in both the process of its adaptation to the Mexican population and the norm development process. This is an effort to contribute to the debate initiated by Suen and Greenspan (2008), who argued in court against the use of Mexican norms in a death penalty case, which depended upon establishing the diagnosis of mental retardation. As a part of the defense team, these scholars argued a number of points against the use of the Mexican norms. With input from the lead researcher on the Mexican standardization process, some of the criticisms are addressed, and further information about the norm development process for this test in Mexico is provided in an attempt to be critical about the strengths and weaknesses of the use of existing Mexican norms. Finally, we argue that results from a single test must not be used to make life and death decisions and that test development is a continuous process influenced by culture,language, and indeed by norm-developing procedures and debates.

Suen, H. K. & Greenspan, S. (2009). Reply to Sanchez-Escobedo and Hollingworth: Why the Mexican Norms for the WAIS-III Continue to be Inadequate. Applied Neuropsychology, 16 (3), 228-229 (click here).

The discussion in Drs. Sanchez-Escobedo and Hollingworth’s paper independently confirms virtually all our observations regarding the psychometric and interpretive deficiencies of the Mexican norms for very high-stakes decisions, such as that involved in an Atkins hearing. Test publishers have an ethical obligation to caution potential users against the premature use of a developing assessment that does not yet meet the needed precision and evidence of validity required for very high-stakes decisions.

Technorati Tags: psychology, educational psychology, school psychology, neuropsychology, criminal psychology, forensic psychology, clinical psychology, mental retardation, MR, Mexican WAIS-III, WAIS-III, WJ III, BAT III, norms, standardization, psychometrics, Atkins, capital punishmen, death penalty, Applied Neuropsychology

Applied Neuropsychology (2009, V16-2) special MR death penalty issue: Editor intro article

The latest issue of Applied Neuropsychology (the table of contents which was provided at this blog previously) includes a series of papers that grew out of the symposium Controversies in Determination of Mental Retardation in Death Penalty Appeals at the annual (2007) American Psychological Association in San Francisco.

Dr. Stephen Greenspan is the editor for the special issue. His introductory article, Assessment and Diagnosis of Mental Retardation in Death Penalty Cases: Introduction and Overview of the Special 'Atkins’ Issue, organizes the articles around three "prongs" used in the definition of mental retardation.

• Intellectual functioning
• Adaptive functioning
• Developmental onset

Most articles fall under one of these three prongs, but a few don't. According to Greenspan, "The final paper, by Olley, addresses the need for psychologists testifying in Atkins cases to have relevant training and experienceinvolving people with mild mental retardation functioning in community settings." Oiley's article articulates the need for experts, who testify or provide declarations for the court in Atkins cases, should have "an adequate understanding of mild mental retardation and, in particular, to avoid making intuitive-clinical judgments based on inappropriate stereotypes more appropriate to people with moderate or severe."

A few other tidbits gleaned from Dr. Greenspan's introductory article follow below:

• A major problem with Atkins cases is that the diagnostic criteria often vary across different state laws and court systems. Many states use an IQ cut-off score of 70 while others allow more flexibility based on psychometric principles such as measurement error (standard error of measurement - more on this in a later post). Thus, a 75 in one state may not meet the diagnostic criteria for MR...while in another it may be considered as a valid score for an individual with MR.
  

• Most states use either the MR criteria published by the American Psychiatric Association (DSM) or the so-called ‘‘red book’’ of the American Association on Mental Retardation (AAMR, recently changed to AAIDD).

• Two issues in intellectual assessment that are very common are the Flynn Effect and the determination of intellectual or adaptive malingering during assessments.
  

• Prong three (developmental criterion) is usually given the least amount of attention in Atkins proceedings.

Technorati Tags: psychology, educational psychology, neuropsychology, forensic psychology, school psychology, developmental, Atkins cases, death penalty, capital punishment, MR, mental retardation, developmental disabilities, Applied Neruopsychology, Stephen Greenspan, IQ, IQ tests, IQ scores, malignering

Applied Neuropsychology (2009, V16-2) special issue on mental retardation and death penalty

The journal Applied Neuropsychology just published a special issue that focuses on the issue of intellectual disabilities (mental retardation) and the death penalty. An advanced copy of the table of contents (that I received a while back) can be viewed here.

The formal listing of articles, authors, pages, and viewable abstracts are available at the Applied Neuropsychology web page for this issue.

Technorati Tags: psychology, forensice psychology, neuropsychology, intelligence, IQ tests, IQ scores, intellectual disability, mental retardation, adaptive behavior, capital punishment, death penalty, Applied Neuropsychology, psychometrics, Supreme Court