Dr. Stephen Greenspan on the definition of MR/ID: The definition is all (or mostly) wet.

In his speech when accepting the 2011 APA Division 33 Jacobson award, Stephen Greenspan made the following comment

Unfortunately, the typical Atkins hearing is less a quest for the truth about individuals than it is a quest for the truth about IQ or adaptive behavior test scores. This is not a new concern, but the much higher stakes in capital cases bring the inadequacies in defining and diagnosing ID into greater relief. Unfortunately, the “physics emulation” phenomenon seems to be getting worse rather than better, in part because the same “scientistic” (superficial embrace of scientific trappings) emphasis on SD‐based cutting scores that has characterized the prong one (intelligence) now seems to have taken over prong two (adaptive functioning), as reflected in new wording in both AAIDD‐11 and in a DSM‐5 draft. Concern about the need for a more responsible approach to testifying in Atkins cases has brought about efforts by myself and colleagues about how ID should and should not be evaluated in criminal proceedings (Greenspan, 2009d, 2011b).

Dr. Greenspan has been an extremely vocal and consistent critique of past and current definitions of intellectual disability. An abridged version of his complete speech was printed in the latest APA Division 33 newsletter (click here and go to page 4), with a note at the end indicating that those who want a copy of the entire speech should contact Dr. Greenspan.

Kudos to Dr. Greenspan for his continued efforts to improve the definition of MR/ID


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Research byte: Greenspan et al on ID/MR and a theory of common sense

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Greenspan on common sense/gullibility and MR/ID

Social intelligence. Social awareness. Foolish action. Common sense. Stephen Greenspan has single handedly advocated for the concept of gullibility to be the core defining feature of MR/ID within AAIDD. His terms have changed, but the concept has remained the same. Currently he is using the term common sense (lack of risk-awareness) to get at this core feature of ID.

His thinking and writings are important for all involved in Atkins cases. Thus, I was pleased to find a copy of one of his recent book chapters on this topic being available for download at his website.

(double click on images to enlarge)

Together with Switzy they have a newer paper "in preparation.". Once that is public I will feature it here at the ICDP blog.


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intelligence intelligence testing Atkins cases ICDP blog psychology school psychology neuropsychology forensic psychology criminal psychology criminal justice death penalty capital punishment ABA IQ tests IQ scores adaptive behavior AAIDD mental retardation intellectual disability social intelligence foolishness risk awareness common sense gullibility

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Comments by an "Eminence Grise": Stephen Greenspan's 2010 AAIDD Atkins MR/ID Death Penalty Symposium commentary

Thanks to Dr. Stephen Greenspan for making his PPT slide presentation, which was part of a 2010 AAIDD Atkins MR/ID Death Penalty Symposium, available for viewing via my SlideShare account (click here).  The file is available for viewing on-line but the download feature has been disabled.  If you want to read a brief summary of the presentation, which includes a link to Greenspan's web page, click here.

Kudos and thanks to Steven.

Peer pressure is now on to have all PPT modules put on-line...including my own...which I will need to construct since I, for the first time EVER, did my presentation from written notes due to time constraints  (darn).

Technorati Tags: psychology, forensic psychology, forensic psychiatry, neuropsychology, intelligence, school psychology, psychometrics, educational psychology, IQ, IQ tests, IQ scores, adaptive behavior, adaptive functioning, intellectual disability, mental retardation, MR, ID, criminal psychology, criminal defense, criminal justice, ABA, Atkins cases, Atkins death penalty, American Bar Association, Atkins cases, death penalty, capital punishment, AAIDD, Atkins MR/ID listserv, ICDP blog, psychiatry, psychiatry and criminal justice

Stephen Greenspan on "60 Minutes" to discuss gullibility

Stephen Greenspan (ANNALS OF GULLIBILITY, Praeger, 2009) is scheduled to appear on a  60 Minute segment scheduled to air on Sun, 2/14 @ 7 pm ET/PT; 6PM Central/ Mtn.  Greenspan has written extensively re: the critical importance of the concept of gullibility as it relates to the definition and identification of individuals with intellectual disabilities/mental retardation (ID/MR).

According to Greenspan, the segment will focus mainly on Ponzi scheme implications, and will not get much or all into other implications, such as criminal justice, cognitive disabilities, Atkins MR death penalty cases, etc.

Technorati Tags: Psychology, forensic psychology, forensic psychiatry, intellectual disabilities, mental retardation, social skills, social intelligence, social cognition, 60 minutes, gullibility, Ponzi schemes

Personal observation: Adaptive behavior as gullibility (S. Greenspan's position)

I've not spent as much time discussing conceptual, theoretical, empirical and measurement issues surrounding the second prong of MR determination...namely, deficits in adaptive behavior.  I simply have not had time to delve into this literature as much as I would like...but I will eventually.

That above being said, I had a personal experience/observation last week consistent with Stephen Greenspan's campaign to ground adaptive behavior in the concept of "everyday intelligence" and the notions of "gullibility" or "foolish actions."

I've been going to a local health club for over 15+ years.  One time I left a nice watch behind in the locker I had used (when done they are unlocked as you take your lock with you)...only to return within an hour (after recognizing that I had left it behind) to find it missing.  No one had turned it in....and it never surfaced.  Another time I left my iPod on a locker bench and went to shower.  Upon return it was MIA....and yes...never to be reported or returned.  I learned my lesson and should have known better.  I tend to be an absent-minded professor at times.

Last week I entered the locker room and saw a watch sitting on the ledge by a large mirror.  As I dressed to work out I kept an eye to see if someone had simply put it down temporarily.  I decided to let it sit.   When I returned after my work out (45 minutes later), the watch was still sitting on the ledge.  I decided that if it was still there when I had showered and dressed that I'd take it to the front desk and give it to them.  Just prior to departure a young man walked in from the swimming pool area and calmly picked up the watch and put it on his wrist.  He clearly had simply left it there on purpose while he swam.  On first glance, he did not look physically different from many other young men...although a bit overweight.  Within a few minutes another young man came from the swimming pool along with an older male.  They started talking and it became clear the two young men were developmentally disabled (mentally retarded in old terminology) and the older man was their caregiver..who had taken them swimming.  As the young man with the watch talked I could tell he was developmentally delayed.

As I left I recognized that this was just one real world indicator of Stephan Greenspan's notion of gullibility.  Clearly this young man had a naive trust in others. He had deliberately left the watch on the ledge so it would not get wet while swimming...with little awareness of the potential for theft.  I believe this would fit under the definition of gullibility.

Just a personal observation that struck a chord.

Technorati Tags: psychology, forensic psychology, criminal psychology, developmental disabilities, school psychology, educational psychology, neuropsychology, MR, mental retardation, intellectual disability, Atkins cases, death penalty, capital punishment, gullibility

Dr. Stephen Greenspan guest comment post: Response to Dr. Judd re: adaptive behavior

Dr. Stephen Greenspan posted a lengthy response comment to Dr. Judd's comment post (re: the original Switzky & Greenspan adaptive behavior chapter post I made-----hope that makes sense and is not another "whose on first" bit). Dr. Greenspan's response can be seen under "comments" at the original Switzky & Greenspan AB chapter post I made. Given that I took Dr. Judd's long comment and turned it into a guest post (with his permission), I'm doing the same for Dr. Greenspan's comments.

Stephen Greenspan said...

I appreciate the kind comments (which I understand are in a guest blog by Dr. Ted Judd) on the chapter “lessons from Atkins” that appeared in WHAT IS MENTAL RETARDATION edited by Harvey Switzky and myself. Unfortunately those lessons do not appear to have been learned. The main point in that chapter is that adaptive behavior as applied in court settings has turned out to be a nightmare, because of the failure to ground it in the notion of “everyday intelligence”. This is a point I have been making in print since 1979, but Atkins experience has proved me more correct than I realized. In Indiana court decisions for example, “adaptive behavior” is frequently described as “adaptation” and any behavior that a defendant engages in which meet a basic need (an example given was eating out of a garbage can when hungry) is used as evidence of normal functioning. Then of course there are the ridiculous “Briseno factors” in Texas, in which their high court came up with a list of adaptive behaviors (such as any evidence of planning) that bear little or no resemblance to mild ID as we know it. What we need is to come up with a notion of “adaptive age” (and eating out of a garbage can would I think be at a pre-toddler—or German Shepherd-- adaptive age equivalent) and get across the notion of adaptive behavior as involving problem-solving at a more abstract level (such as understanding when an interrogator assuring you that confessing is in your interest is being deceptive). The forthcoming AAIDD manual (which I understand is likely to become known as “the green book”) basically just changes MR to ID, makes a few format improvements, but keeps the same primary emphasis on IQ and retains a construct of adaptive behavior that lacks any connection to “intelligence” broadly defined. My self-assigned task has been to try to find aspects of adaptive behavior deficit (such as “gullibility” and “foolish action”) that are more intellectually-grounded and that could be considered universal diagnostic indicators of ID (as framed by the red/ green books, there is no aspect of adaptive behavior which is central to the ID construct). I am working on a paper (invited by AAIDD classification committee chair Robert Schalock) that elaborates on all the reasons why I think the green book missed the boat (I will preview it as a guest blog here, by kind invitation of Dr. McGrew). Chief among these (which has profound implications for Atkins cases) is that AAIDD missed the opportunity to define the construct more broadly, to include the many people with brain-based disorders who fit the behavioral phenotype for ID but have IQ scores that are a little too high. (Harvey and I wrote our chapter very early in our Atkins experiences, and we naively wrote that attorneys in these cases do not make a big deal out of one or two IQ points. We have of course course learned that everything is disputed, especially one or two IQ points). I am honored that AAIDD cites me as providing the theoretical framework for the model of adaptive behavior but I need to point out that what I had in mind was a tripartite model of “adaptive intelligence” (which cause adaptive behavior to fade away) and and not continuing to view adaptive behavior as some vague add-on construct that involves such things as “has good breath” (an item on the ABAS-2)--better would be “understands the social and physical risks of having bad breath.”

Steve Greenspan (for my recent paper on “foolish action”, click on www.stephen-greenspan.com)

Technorati Tags: psychology, educational psychology, special education, developmental disabilities, mental retardation, forensic psychology, criminal psychology, clinical psychology, school psychology, AAIDD, AAMR, adaptive behavior, adaptive functioning, gullibility, social skills

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

• Judd, T. & Beggs, B. (2005). Cross-cultural forensic neuropsychological assessment (pp. 141-162). In K. Barrett & W. H. George (Eds.) Race, Culture, Psychology and Law. Thousand Oaks, CA: Sage Press. Reprinted (2006) (pp. 175-186) in C.R. & A.M. Bartol (Eds.) Current Perspectives in Forensic Psychology and Criminal Justice. Thousand Oaks, CA: Sage Press.

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: psychology, forensice psychology, criminal justice, criminal psychology, developmental disabilities, educational psychology, neuropsychology, school psychology, mental retardation, MR, Atkins cases, death peantly, capital punishment, adpative behavior, adaptive functioning, gullibility

Rethinking adaptive behavior in light of MR Atkin's cases: Greespan and Switzky (2006) chapter

Although the primary focus of this blog is on the intellectual component of MR definition, assessment, etc. in Atkin's cases, material related to the second component of the MR definition (adaptive behavior) will also be covered. I have a long standing research interest in adaptive behavior which I will mention in a future post. When appropriate this blog will comment on conceptual, theoretical, and esp. measurement issues surrounding both intellectual competence and adaptive behavior

I just read a the following very thought provoking book chapter by Greenspan and Switzky.

• Stephen Greenspan & Harvey N. Switzky (2006). Lessons from the Atkins decision for the next AAMR manual. In H.N. Switzky & S. Greenspan (Eds.), What is Mental Retardation?: Ideas for an evolving disability in the 21st century. (pp. 281- 300). Washington, DC: American Association on Mental Retardation. (click here to view chapter; click here to view book at AAIDD web page)

Based on their considerable experience as testifying experts in Atkin's MR/death penalty case, primarily with reference to the definition, assessment, and theoretical issues related to adaptive behavior, Greenspan and Switzky make numerous suggestions re: how the next version of the AAMR/AAIDD mental retardation manual should be changed, in light of the emerging prominent role of the manual in Atkin's cases. Atkin's cases have, more-or-less, forced the need to reexamine some of the underlying concepts and thinking related to the conceptualization and measurement of adaptive functioning.

Some of the key issues and ideas discussed are:

• Problems and potential solutions to the self-rating format of adaptive behavior (AB) assessment tools
• The need for multiple raters
  
• "Reverse malingering" - individuals with mild MR having a tendency to exaggerate their level of skills and competence to try hide their disability
• The failure of many AB instruments to provide adequate coverage of one of the critical components of AB: social skill deficits, social vulnerabilty, guillability, etc.
• The problems in judging level of adaptive functioning based on the tasks involved in completing a crime
• The suggestion to change the name of the construct to adaptive functioning--to jetison some of the historical baggage that is associated with the current AB term.
  
• The inherent problems in judging adaptive functioning from clinical interviews, given the ability of many individuals with mild MR to "sound" more intelligent than they are.
• Issues and ideas for establishing levels of AB retroactively (e.g., at the time the crime occured; the person's functioning before the age of 18)
• The over-reliance on IQ scores and the suggesting to reverse the weight given to IQ and AB in the definition of MR.
• The suggestion to bring back the "borderline" category of MR

It is clear that Greespan and Switzky have had considerable experience in addressing the AB component in Atkin's cases and their experiences have produced keen insights (and possible ideas) for improving the conceptualization, measurement, and use of AB definitions, measures, and scores in court settings. I can't wait to see the entire book.

Technorati Tags: psychology, developmental disabilities, MR, mental retardation, AAIDD, AAMR, Atkins cases, SCOTUS, malingering, adaptive behavior, death penalty, capital punishment, intellectual disability