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Understanding Autism

Parents are usually the first to notice their child having difficulty and failing to meet developmental milestones. Some things parents might notice are lack of joyful facial expressions by six months, difficulty engaging in give and take interactions by nine months, and delayed language development.

There are three distinctive areas of difficulty which characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling.

The hallmark feature of autism is impaired social interaction. Some children show hints of problems within the first few months of life, while others may not show deficits until they are two years old or later. Some children may develop normally until the age of two, but then they stop making gains in language and social skills or they lose skills that they had already acquired. No two children with autism are alike and presentation may vary significantly.

Autism impacts 1 in 150 people. It occurs in all racial, ethnic, and socioeconomic groups. Autism is four times more likely to occur in boys. Autism impacts one’s overall ability to communicate with and relate to others. Symptoms range from mild to severe. There are five disorders that fall under the Autism Spectrum. These include Asperger Syndrome, Rett Syndrome, Pervasive Developmental Disorder, NOS, and Childhood Disintegrative Disorder.

As children with autism grow up, they may respond differently to their environment. Many adolescents are overwhelmed by the transition between childhood and adulthood. Parents should expect this to be true of adolescents with autism as well. While some behaviors improve during teenage years, some tend to get worse. You may notice an increase in repetitive and aggressive behaviors as the teen has difficulty managing the stress and confusion associated with adolescence. Not to mention the physical and hormonal changes!  This is also a time where the teen is at risk for developing anxiety or depression as they become increasingly aware that they are different from their peers.

Treatment: The presentation of autism and other spectrum disorders varies significantly in adults. Some are able to live independently and maintain employment while others have significant difficulty completing daily tasks.

Long before your child finishes school, parents should research available social supports to assist your child with autism in adjusting to the “adult world.”

While there is no identifiable fully effective cure for autism, early intervention obtains maximum benefits for your child. Early intervention should focus on improving communication, social, and cognitive skills.

Although there is no single treatment protocol for all children with autism, most individuals respond best to highly structured behavioral programs.

Psychosocial and behavioral interventions are key parts of comprehensive treatment programs. In addition to these interventions, therapies often include occupational therapy, sensory integration therapy, and speech therapy.

If you have concerns about your child’s development, speak to your pediatrician to determine the best course of action and complete screenings with other qualified professionals, such as a psychologist.
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September is National Alcohol
and Drug Addiction Recovery Month

Like all behaviors, drug and alcohol use occurs along a continuum. Some of us drink ‘socially’ or use drugs ‘recreationally.’ Others find themselves using substances in a way which leads to some mild impairment in their lives while others use to an extent that can be devastating or even deadly.

A common misconception is that the user does not wish to quit and is content with their use. Most ‘addicts’ desperately want to end their dependency but have had little success because of the chemical and psychological dependence. They may earnestly try to quit but soon return to their habit when attempting to quit without assistance. Therapists, trained in substance use, can help an individual combat their use, help their family, and make recommendations for when medical intervention is necessary.

Not all substances are illegal drugs. Some common household products can be ingested to achieve a ‘high.’ Some drugs are inhaled, such as powdered cocaine, while others are ‘huffed’ such as gasoline and glue. Common prescription medications can be used such as Valium, Xanax, or Oxycodone. Other drugs that are taken in pill form, which are called ‘uppers’ and ‘downers,’ include amphetamines, sedatives, pain killers, and hallucinogens. Injectable drugs include heroin. Smokeable drugs include crack cocaine, marijuana, and cigarettes. Alcohol is also considered a substance and common household products such as vanilla extract made be ingested as well.

There are two distinct categories of problem substance use, abuse and dependence.

Substance abuse involves the recurrent use of a chemical that leads to distress for the individual or people around them. Difficulties can include: (1) not fulfilling major role obligations at work, home, or school such as repeated absences or neglect of one’s children; (2) placing oneself in physically hazardous situations, such as drinking and driving, or (3) legal problems such as disorderly conduct. Also, despite overwhelming physical and social difficulties, such as arguments with a partner or physical fights, abusers will continue their habit.

Substance dependence or ‘addiction’ also involves the recurrent use of a chemical. Individuals who become dependent on substances develop tolerance and/or withdrawal. Tolerance occurs when an individual needs more of the substance to have the same effect and/or has less of an effect when using the same amount. Withdrawal includes physical symptoms that are specific to the substance and/or taking the substance to avoid the withdrawal. Therefore, when someone attempts to quit using it, they often claim to “not feel quite right” and return to their addiction.

Other symptoms of dependence include: (1) taking the substance in larger amounts or over longer periods than was intended; (2) a persistent desire or unsuccessful effort to cut down on use; (3) spending a great deal of time in activities to obtain the substance; (4) giving up or reduced participation in important social, work, or fun activities; (5) using despite knowing that it is problem. There are psychological symptoms associated with dependency as well. For example, smokers who use a cigarette during a specific time each day may feel the need to smoke during that time. Alcoholics going to a restaurant with friends may have the urge to drink solely because there is alcohol available.

If you or someone you love struggles with substance use or dependence, there are many ways to find help. Our website Resources page lists some free or reduced fee local resources. At Lepage Associates we have psychologists who specialize in working with users, and family and friends affected by use. Our Addictions & Compulsions group, Co-Dependency Support group, DBT group, and Women’s group can also be helpful. Our Substance Abuse Assessment can help you determine what level of treatment is required for a person struggling with this problem. Our staff would be happy to speak with you and provide more information and guidance.

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Suicide Prevention Can Help Save Lives

September also houses National Suicide Prevention Week. The major elements of suicide prevention include awareness, open communication, and knowledge of access to resources.

A suicidal crisis often occurs when someone is experiencing an intense depression. You may notice changes in someone’s behavior such as negative thoughts and actions, harmful acts, and deteriorative functioning. Despite the intensity of suicidal thoughts, they are usually associated with problems that can be treated. Individuals experiencing a suicidal crisis are usually overwhelmed and are unable to think of alternative solutions in their current state of mind. Therefore, people need help from their loved ones to encourage them to get help. Suicidal crises are almost always temporary and the most important aspect is getting through the crisis without self harm.

Awareness

Risk factors for suicide include psychiatric disorders, genetic predisposition, history of attempted suicide, and impulsivity. Other warning signs are: (1) looking for ways to die (internet searches, acquiring a gun or pills, etc), (2) preoccupation with death, (3) becoming suddenly happier and calmer, (4) loss of interest in things the individual used to care about, (5) visiting or calling people one cares about (good-bye calls), (6) making arrangements to settle affairs, and (7) giving things away (such as prized possessions).

You can use this common acronym when assessing risk factors:

I – Ideation (thinking, talking, or wishing about suicide)
S – Substance use or abuse (increased use or change in substances)

P – Purposelessness (no sense of purpose or belonging)
A – Anxiety (restlessness, irritability, agitation)
T – Trapped (feeling like there is no way out)
H – Hopelessness (there is nothing to live for, no hope or optimism)

W – Withdrawal (from family, friends, work, school, activities, hobbies)
A – Anger
R – Recklessness (high risk-taking behavior)
M – Mood changes (dramatic changes in mood)

Open Communication

It is a common misconception that talking about suicide can give someone the idea of suicide. If you are recognizing the warning signs of suicide, do not be afraid to ask about it. Initiating this conversation can give the individual the opening to discuss their thoughts and feelings.  If you fear that someone may take their life, be willing to listen and take them seriously. If you are feeling suicidal…Do not keep these thoughts to yourself!  There are people willing to listen and offer a helping hand.  

Resources

There is no shame in seeking professional help. If there is a risk of suicide do not leave the person alone until help is available, and remove any sources that can aid in a suicide attempt. Do not hesitate to call 911 or take the person to the nearest emergency room. It is important to encourage the individual to follow up with treatment once the suicidal crisis passes. There are many protective factors that an individual can use including the assistance of professionals. Other resources include family and community support, skill building, and religion/spirituality. Helping the individual identify reasons for living can help sustain a person in pain.

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Post Traumatic Stress Disorder (PTSD)

What is PTSD and what does it have to do with my case?

Traumatic events can include, but are not limited to, military combat, violent personal assault (rape, domestic violence), being kidnapped, being taken hostage, terrorist attack, torture, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness.  It can result in substance use, depression, and anxiety.

Trauma can complicate any legal case. Your client may have difficulty participating in the legal process and require therapy. The event precipitating legal action may be the cause of the trauma and need to be considered in a settlement case. PTSD can also be malingered. If you are able to recognize the symptoms of PTSD, you can obtain an expert to help argue a stronger case for your client.

A person should be evaluated for PTSD if they witnessed, experienced, or were confronted with an event that involved actual or possible death, grave injury, or threat to physical integrity. However, having the experience does not in itself lead to a diagnosis of PTSD. The person’s response must have included severe helplessness, fear, or horror. In children, this may be expressed instead by disorganized or agitated behavior. Further, in order to receive a diagnosis of PTSD, the following symptoms must occur for at least one month and interfere with one’s work, family, and/or social life. Several symptoms must occur in a number a categories, it’s actually quite a high bar to be diagnosed with PTSD.

1. Reexperiencing symptoms– at least one must be present:

1. Memories of the trauma which intrude into consciousness repetitively, without warning, without triggers, or reminders to elicit them. In children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2. Vivid reenactments or flashbacks of the event. In children, trauma-specific reenactment may occur.
3. Nightmares about the event. In children, there may be frightening dreams without recognizable content.
4. When faced with actual or symbolic cues related to the event, the person has intense psychological reactions such as terror or physiological responses such as increased heart rate.
5. The symptoms are viewed as intrusive and distressing because the person has no control over when or how they occur.

2. Avoidance and numbing symptoms– at least three must be present:

1. Avoidance of thoughts and feelings about the trauma.
2. Avoidance of situations and events that remind the person of the trauma.
3. The person actually forgets specific aspects of the trauma.
4. One is cut off from both positive and negative emotions.
5. These symptoms make it hard to relate to others, enjoy life, remain productive, and plan for the future.

3. Physiological hyperarousal – at least two must be present:

1. A state of fight or flight exists similar to the response during the traumatic event.
2. One is primed for danger in most situations even when it’s safe.
3. Difficulties with sleep, concentration, and/or irritability are present.
4. People can have very strong startle reactions as well.

Can you have trauma and not have PTSD?

Most people exposed to trauma do not develop PTSD. In fact, a major study that surveyed almost 6,000 people found most had experienced at least one major traumatic event. It has been theorized that people who experience trauma who do not develop PTSD have protective factors such as a high level of education and considerable social and emotional support.

What causes PTSD?

Research indicates that about 20% of women and 8% of men who experience traumatic events are likely to develop PTSD. The types of trauma that are more likely to lead to the development of PTSD include rape, combat, childhood neglect, childhood physical abuse, threat with a weapon, sexual molestation, and a physical attack.

There is some research that suggests certain individuals are predisposed to develop PTSD when exposed to trauma. Some people are more prone to perceive a situation as dangerous and to be more physiologically reactive. For example, subjects with PTSD exhibit higher resting heart rates than those without PTSD. There are several risk factors for developing PTSD which include: female sex; neuroticism; lower social support; lower IQ; preexisting psychiatric illness, especially mood and anxiety disorders; childhood physical or sexual abuse; childhood separation from parents; a family history of mood, anxiety, or substance abuse disorders; and family instability. If someone dissociates (mentally disconnects) at the time of the event they are also more likely to develop PTSD.

There are multiple theories for the development of PTSD. An individual with PTSD has learned to associate events related to the trauma with fear, and avoidance with escape. Therefore, when someone encounters a fearful situation they experience the avoidance and numbing symptoms described above. Intrusive reexperiencing symptoms appear related to mental fear structures that form a network in the memory. This fear network is activated by reminders of the trauma and, again, avoidance behaviors are employed. This activation also interferes with daily life because it impacts a person’s belief system and her or his expectations of the world are shattered. These include beliefs about safety, trust, control/power, self-esteem, and intimacy. Therefore the person often blames them self for the event and feels shame or embarrassment.

Does it interfere with someone’s ability to work?

PTSD does not resolve quickly. If symptoms are not resolved within about three months then they tend to persist over time and worsen without appropriate intervention. PTSD can co-occur with a number of problems such as pain, depression, anxiety, substance abuse, and personality disorders. Not only does PTSD affect a person’s emotional and interpersonal functioning but it also affects the body in several different ways. For example, people with PTSD exhibit higher heart rate, blood pressure, and skin conductance (sweaty palms). People with PTSD are more prone to startle in reaction to loud noises as evidenced by larger eye blink and brain wave responses. Exposure to inescapable stress releases chemicals in the brain that blunt sensitivity to pain which may underlie numbing. Acute stress triggers the release of excessive stress hormones which suppresses the immune and metabolic systems thus making someone more prone to illnesses. In other words, if PTSD goes untreated it can interfere with someone’s ability to work. However, with appropriate treatment, most people with PTSD can return to a normal level of functioning, including work.

References:

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: APA.
McNally, R. (1999). Posttraumatic Stress Disorder. In T. Millon, P. Blaney, and R. Davis
(Eds.), Oxford textbook of psychopathology (pp.144-165). New York: Oxford University Press.

Resick, P., and Calhoun, K. (2001). Posttraumatic Stress Disorder. In D. Barlow (Ed.),
Clinical handbook of psychological disorders, third edition (pp. 60-113). New
York: The Guildford Press, NY.

Whealin, J., and Slone, L. Complex PTSD. National Center for PTSD Fact Sheet. https://www.ncptsd.va.gov/ncmain/ncdocs/fact_shts/fs_complex_ptsd.html
Retrieved 3/26/08.

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Psychological Forensic Evaluations

What is the difference between a clinical psychological evaluation and a forensic evaluation?

How do you pick the right expert for your evaluation?

Knowing when and how to obtain a forensic evaluation – which typically goes beyond the scope of a basic clinical interview – could make or break your case.

Following are several things you should look for in a forensic evaluation:

• In all evaluations, psychologists complete a clinical interview with the client. Some psychologists stop here, and while a clinical interview is certainly better than no evaluation, it is not the most thorough method of assessment as it is purely self-report.
• It is more helpful to use psychological testing so that the bulk of information is not based on the client’s self-report. Many psychologists administer psychological instruments such as the Minnesota Multiphasic Personality Inventory (MMPI-2), which is an objective measure of personality and major categories of psychopathology. The MMPI-2 is widely used because it is well known to be a reliable, valid test. It also has a Lie Scale to help determine if someone is trying to form a favorable impression or mislead the examiner regarding severity of illness. However, though better than an interview only, this test is, again, based on the client’s self-report.
• It is therefore recommended that multiple tests be completed. A full battery should look at the client’s cognitive, emotional, and personality functioning. A battery gives added weight to your argument that the client was fully evaluated. (Tests that are specific to the situation are described below.) This may be where some psychologists end their evaluation.
• However, a full battery could still be a clinical evaluation and not a forensic evaluation. According to the American Academy of Forensic Psychology, a full forensic evaluation includes actively seeking information from more than one source that would differentially test plausible rival hypotheses. This means psychologists need to actively seek prior records. They also need to talk to people who know the client, to assess both pre- and post-functioning. These collateral contacts are not only family members with a vested interest in the client, but also professionals or disinterested parties who will provide impartial accounts of the client.

Competency to Stand Trial

• Psychologists can help determine if your client has an adequate understanding of the legal proceeding and ability to work with you. The focus of the evaluation is on current functioning and mental status. Psychologists can administer psychological instruments such as the MacArthur Competence Assessment Tool-Criminal Adjudication. This instrument helps the psychologist determine if the client understands the charges and trial process as well as her appreciation of relevance of information for her defense. This instrument also helps uncover the client’s ability to reason during decision making tasks and her logical problem-solving abilities.
• A subset of this type of evaluation is competency to plead guilty. The psychologist helps determine if the client understands the criminal process, is able to work with the attorney, why she wants to plead guilty, and her understanding of the implication of relinquishing certain rights.

Competency of Juveniles

• The community often disagrees on the topic of whether juveniles should be tried as adults. Psychological research suggests one’s cognitive abilities are still developing in most “normal” children prior to age 14, that is, a child without mental disorders or cognitive disabilities. Therefore a child’s ability to understand information that is provided to defendants regarding the trial process, and to reason with the information that they acquire or bring to the situation, is not fully developed. It is suggested that most children under 12 be evaluated. As should children with a history of mental illness or mental retardation, borderline intellectual functioning, and learning disabilities. If you observe that your young client has deficits in memory, attention, or interpretation of reality you may consider an evaluation as well.
• A psychologist should look at psychosocial factors such as self-control, self-concept, relationships with adults in authority, and the child’s capacity for perspective taking in decision making.

The Insanity Defense

• Psychologists can help determine your client’s mental condition at the time of the offense and if they should be held responsible for the crime committed. North Carolina insanity laws are based on the McNaughton standard, which asks if the client is suffering from a mental disease (mental illness) or defect (mental retardation). If so, did it impact their ability to know and understand the nature and quality of their act? Was the client able to understand and appreciate what they were doing was wrong? This standard emphasizes the quality of one’s thought process and their perception of reality. The burden of proof is on the prosecution.
• Some psychologists use the Rogers Criminal Responsibility Assessment Scale which looks at brain disorders, mental disorders, behavioral control, the ability to control one’s thoughts, and reliability of the person’s report.

Malingering

• Psychological instruments can be administered such as the MMPI-2; however, as stated earlier, it is a self-report measure. More sophisticated measures of malingering are instruments such as the Structured Interview of Reports Symptoms (SIRS). The SIRS assesses a variety of areas such as defensiveness, uncommon symptoms, changes in behavior during the assessment, and common symptoms. One can determine if someone is trying to fake memory problems by using an instrument such as the Test of Memory Malingering.

Death Penalty Cases

• North Carolina has instituted laws against executing individuals with mental retardation. There is also a push to create legislature regarding execution of individuals with severe and persistent mental illness. Therefore, a psychologist may help determine if a client is competent to be executed. An assessment of mental retardation would include cognitive testing such as the Wechsler Adult Intelligence Scale (WAIS-R) and might include neuropsychological testing regarding brain injury. In these cases, there needs to be evidence that mental retardation was present prior to age 18 so record review and speaking with collateral contacts is vitally important.

References:

American Academy of Forensic Psychology website listed below:
https://www.ap-ls.org/links/currentforensicguidelines.pdf

Wrightsman, L. & Fulero, S. (2005). Forensic Psychology, Second Edition. Thomson Wadsworth.

Click here to download this article as a PDF
Click here to return to Forensic Psychology Articles

Psychological Forensic Evaluations

What is the difference between a clinical psychological evaluation and a forensic evaluation?

How do you pick the right expert for your evaluation?

Knowing when and how to obtain a forensic evaluation – which typically goes beyond the scope of a basic clinical interview – could make or break your case.

Following are several things you should look for in a forensic evaluation:

• In all evaluations, psychologists complete a clinical interview with the client. Some psychologists stop here, and while a clinical interview is certainly better than no evaluation, it is not the most thorough method of assessment as it is purely self-report.
• It is more helpful to use psychological testing so that the bulk of information is not based on the client’s self-report. Many psychologists administer psychological instruments such as the Minnesota Multiphasic Personality Inventory (MMPI-2), which is an objective measure of personality and major categories of psychopathology. The MMPI-2 is widely used because it is well known to be a reliable, valid test. It also has a Lie Scale to help determine if someone is trying to form a favorable impression or mislead the examiner regarding severity of illness. However, though better than an interview only, this test is, again, based on the client’s self-report.
• It is therefore recommended that multiple tests be completed. A full battery should look at the client’s cognitive, emotional, and personality functioning. A battery gives added weight to your argument that the client was fully evaluated. (Tests that are specific to the situation are described below.) This may be where some psychologists end their evaluation.
• However, a full battery could still be a clinical evaluation and not a forensic evaluation. According to the American Academy of Forensic Psychology, a full forensic evaluation includes actively seeking information from more than one source that would differentially test plausible rival hypotheses. This means psychologists need to actively seek prior records. They also need to talk to people who know the client, to assess both pre- and post-functioning. These collateral contacts are not only family members with a vested interest in the client, but also professionals or disinterested parties who will provide impartial accounts of the client.

Competency to Stand Trial

• Psychologists can help determine if your client has an adequate understanding of the legal proceeding and ability to work with you. The focus of the evaluation is on current functioning and mental status. Psychologists can administer psychological instruments such as the MacArthur Competence Assessment Tool-Criminal Adjudication. This instrument helps the psychologist determine if the client understands the charges and trial process as well as her appreciation of relevance of information for her defense. This instrument also helps uncover the client’s ability to reason during decision making tasks and her logical problem-solving abilities.
• A subset of this type of evaluation is competency to plead guilty. The psychologist helps determine if the client understands the criminal process, is able to work with the attorney, why she wants to plead guilty, and her understanding of the implication of relinquishing certain rights.

Competency of Juveniles

• The community often disagrees on the topic of whether juveniles should be tried as adults. Psychological research suggests one’s cognitive abilities are still developing in most “normal” children prior to age 14, that is, a child without mental disorders or cognitive disabilities. Therefore a child’s ability to understand information that is provided to defendants regarding the trial process, and to reason with the information that they acquire or bring to the situation, is not fully developed. It is suggested that most children under 12 be evaluated. As should children with a history of mental illness or mental retardation, borderline intellectual functioning, and learning disabilities. If you observe that your young client has deficits in memory, attention, or interpretation of reality you may consider an evaluation as well.
• A psychologist should look at psychosocial factors such as self-control, self-concept, relationships with adults in authority, and the child’s capacity for perspective taking in decision making.

The Insanity Defense

• Psychologists can help determine your client’s mental condition at the time of the offense and if they should be held responsible for the crime committed. North Carolina insanity laws are based on the McNaughton standard, which asks if the client is suffering from a mental disease (mental illness) or defect (mental retardation). If so, did it impact their ability to know and understand the nature and quality of their act?  Was the client able to understand and appreciate what they were doing was wrong? This standard emphasizes the quality of one’s thought process and their perception of reality. The burden of proof is on the prosecution.
• Some psychologists use the Rogers Criminal Responsibility Assessment Scale which looks at brain disorders, mental disorders, behavioral control, the ability to control one’s thoughts, and reliability of the person’s report.

Malingering

• Psychological instruments can be administered such as the MMPI-2; however, as stated earlier, it is a self-report measure. More sophisticated measures of malingering are instruments such as the Structured Interview of Reports Symptoms (SIRS). The SIRS assesses a variety of areas such as defensiveness, uncommon symptoms, changes in behavior during the assessment, and common symptoms. One can determine if someone is trying to fake memory problems by using an instrument such as the Test of Memory Malingering.

Death Penalty Cases

• North Carolina has instituted laws against executing individuals with mental retardation. There is also a push to create legislature regarding execution of individuals with severe and persistent mental illness. Therefore, a psychologist may help determine if a client is competent to be executed. An assessment of mental retardation would include cognitive testing such as the Wechsler Adult Intelligence Scale (WAIS-R) and might include neuropsychological testing regarding brain injury. In these cases, there needs to be evidence that mental retardation was present prior to age 18 so record review and speaking with collateral contacts is vitally important.

References:

American Academy of Forensic Psychology website listed below:
https://www.ap-ls.org/links/currentforensicguidelines.pdf

Wrightsman, L. & Fulero, S. (2005). Forensic Psychology, Second Edition. Thomson Wadsworth.

Click here to download this article as a PDF
Click here to return to Forensic Psychology Articles

Matthew Silliman’s death has everyone thinking; how could such a horrible crime be perpetrated by such young people? Four teenagers allegedly kidnapped, tortured, and killed Matthew, and he was thought to be their friend. A major issue brought to the forefront with this crime is the group dynamic. Would such as crime have been committed if one person objected? Would one person have committed this crime on their own?

There are several major tenants of social psychology at play with group crimes. Many of these phenomena are heightened in adolescents and young adults (12-21) given their general tendency to be concerned with how others are evaluating them, which is called evaluation apprehension.

Being around people in general arouses us. Heightened arousal increases stress, which is called social facilitation. It we experience mild to moderate levels of stress (like work or school) we may increase our level of performance. However, if there is a high level of stress (like pressure from a peer group to commit a crime), we tend to perform more poorly, i.e., our decision-making is affected.

In groups, people can experience a sense of deindividuation, a loss of self-awareness and evaluation apprehension. This occurs in group situations that foster responsiveness to group norms, whether they are good or bad. A notorious example is the Rodney King beating. This is, in part, because people feel more anonymous in a group. This diminished self-awareness disconnects one’s behavior from one’s attitudes or values. Another component is group polarization, a group-produced enhancement of the members’ preexisting tendencies. This is a strengthening of the member’s average tendency, not a split within the group. In other words, not every person in the group will have a preexisting tendency towards crime. However, a risky shift can occur where the group is willing to make a riskier decision than they would as individuals. Group consensus may occur and after discussions individuals also alter their ways of thinking about the situation often because they want to be accepted by others.

Group think is an exaggerated example of this phenomenon. Group think occurs when an   amiable, cohesive group exists, there is relative isolation of the group from dissenting viewpoints, and there exists a directive leader who signals what decision she or he favors. Several processes occur within the group:

• They tend to overestimate their invulnerability.
• There is an unquestioned belief in the group’s morality.
• Group members rationalize their decisions and behavior and close off their minds to other possibilities.
• They tend to view their ‘opponent’ through stereotypes that the other person is too weak or unintelligent to defend themselves against the planned initiative.
• There is pressure to conform to the group.
• People censor their disagreements which creates an illusion of unanimity.
• Some members of the group become mindguards and protect the group from information that would call into question the effectiveness or mortality of its decisions.

Since not all groups of people commit acts of violence, you still may be asking, what happened? What contributes to violence? While there are always several reasons for someone to become violent, there are some general conditions in most cases. There tends to be a pattern of interactions between genetics, temperament, the family system and socioeconomic level, the school and community environments.

Family environments where there is physical abuse, sexual abuse, conflict in the home, and/or broken-families may influence the development of criminal behavior. These families tend to display a lack of warmth, have limited involvement and supervision, and/or inflict harsh corporal, lax, or inconsistent discipline. Poor parent-child relations, antisocial parents, and rigid traditional gender roles with patriarchal values has also been found to contribute to the development of violent behavior.

Genetic factors such as low IQ and being male contribute to being violent individuals.

Temperament plays a role such that some people are more prone to have high needs for stimulation, to learn slowly from consequences, and do not feel as anxious when they are doing things wrong.

Individuals with few economic resources are at higher risk of both perpetrating and being victimized by physical violence. Also, being a member of an ethnic minority group, although this is complicated with socioeconomic status in our country and related to lack of resources, also tends to elevate the chances of violence. This is further connected to criminal behavior, disorganization, and drug use in the community.

On an individual basis, there are warning signs of possible violent behavior. None of these alone suggests someone may be violent. Again, there is an interaction between the above mentioned risk factors and these behaviors.

1.      Low school grades, school failure, and drop-out.

2.      Poor social ties, delinquent peers, and gang involvement: The most important factor that distinguishes a gang from a healthy group of friends is the violent, criminal behavior of the members, for example some illicit drug activities. If a young male is involved with a gang, he will likely be violent along with other gang members.

3.      Restlessness and difficulty concentrating – Attention-Deficit/Hyperactivity Disorder can be a precursor to antisocial behavior.

4.      Risk taking such as reckless driving.

5.      Substance use – Alcohol and marijuana are just as dangerous as other drug use.

6.      Victimization by others.

7.      Early sexual activity.

8.      Conduct disorder which is characterized by:

a.      Aggression toward people and animals

b.      Destruction of property

c.      Deceitfulness or theft

d.      Serious violations of rules

If you, or someone you know, have concerns about an adolescent, it is always a good idea to seek a consultation from a psychologist who specializes in teenagers. In particular, if your concern is that the teen may be prone to violence, is spending time with other teens that engage in violence, or is engaging in violent behavior him or herself, be sure to choose a psychologist experienced with delinquent teenagers and juvenile delinquency diversion.

Early intervention can be key in preventing escalating juvenile delinquent behavior and adult criminal behavior, and studies have shown therapy to be effective even when the adolescent or adult does not want to go (such as when parents make a child go or when the courts order therapy).

References:

Myers, D.G. (2002). Social Psychology (7^th Edition). New York, NY: McGraw-Hill Companies, Inc.

Glicken, M.D. (2004). Violent Young Children. Boston, MA: Pearson Education, Inc.

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Using Psychological Testing in Child Custody Evaluations

Child custody evaluations have evolved over the years. A shift has occurred from the ‘tender years doctrine,’ which presumed it was best for young children, and girls of any age, to be in the custody of their mother, to the ‘best interest of the child’ standard. With this newer standard, neither parent is believed to have an innate right to the child. The court must consider the mental and physical health of the parents and other individuals involved in childcare; the ability to provide food, clothing, medication, and other material benefits to the child; the interaction and relationship between the child and parent; and the wishes of the parents and child. This allows fathers greater access to the custody of their children. It also makes custody decisions more complicated and conflict laden.

Psychologists are therefore often asked to conduct child custody evaluations. Psychologists are encouraged to gather multiple data on parental capacity, the child’s adjustment, and the parent-child bond. Therefore, the child is interviewed alone and each parent is interviewed separately. Both parents are observed in a separate interaction with the child. Psychological testing is also often used to objectify the process. The most commonly used instruments are the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Rorschach Inkblot Test, Thematic Apperception Test (TAT), and Wechsler Adult Intelligence Scale (WAIS). However, more traditional tests such as these do not directly assess parenting skills. For example, while most psychologists, attorneys, and judges are familiar with these tests, they were not created to assess parenting capacity and are not directly related to the parent-child relationship.

The MMPI-2 assesses truthfulness, mental illness, and maladaptive personality traits, which are important factors in parenting. However, it should not be used as a standalone test as it does not directly assess how these traits impact the individual’s parenting. The Rorschach meets professional standards in the field but is highly controversial, has limited acceptability in court, and does not directly answer questions related to parenting. Therefore, if the MMPI-2 or Rorschach are used it should be to address the mental health of the parents and the data should be interpreted appropriately to reflect mental state rather than parental capacity. Intellectual capacity, as measured by the WAIS, has no direct bearing on parenting capacity unless there is a question of mental retardation. The TAT also has limited acceptability in court, has limited validity and reliability, and does not directly answer questions related to parenting.

Therefore, several tests have been developed to more directly gauge parenting. The Parent-Child Relationship Inventory (PCRI), Parenting Stress Index (PSI), and Children’s Reports of Parental Behavior (CRPB) are valid and reliable indicators of parental abilities.

The PCRI assesses the parent’s attitudes toward parenting and their children on domains of parental support, satisfaction with parenting, involvement, communication, limit setting, autonomy, and role orientation. Parents who implement discipline well have high scores and those who are referred for court-ordered mediation, and are at risk for child abuse, have low scores. The PSI identifies stressful factors within the child such as adaptability, demandingness, mood, distractibility/hyperactivity, and how acceptable and gratifying the child is to the parent. It also measures stressful factors in the parent’s life and interactions with the child such as depression, sense of competence, level of attachment to the child, spousal support, parental health, level of role restriction, and social interaction. The PSI appears to be a good predictor of which parent feels stressed by their child. The CRPB assesses a child’s perception of their parent’s warmth, acceptance of autonomy, limit setting, positive involvement, rejection, hostile control, intrusiveness, and inconsistent discipline. This is a good measure to help assess the child’s view of the situation that does not solely rely on questions they may have been prepped by their parent to answer.

Given that tests exist which more accurately assess parenting, it is suggested that data be gathered from such tests rather than purely from traditional tests. It is also expected that information will be gathered from alternative sources of information, such as interviews, observations, record review, and psychological testing will be used as a supplement to this information. Traditional tests should be used for their intended purposes only. When they are used, they should be used in conjunction with other materials and interpreted appropriately.

References:

Abidin, R. (1990). Parenting Stress Index (3^rd ed.). Odessa, FL: Psychological Assessment

Resources.

Allison, J. (1998). Review of the Parenting Stress Index. In J. Conoley & J. Imapara (Eds.),The twelfth mental measurements yearbook (pp.722-723). Lincoln: University of Nebraska Press.

Bricklin, B. (1999). The contribution of psychological tests to child custody evaluations. In R. Galatzer-Levy & L. Kraus (Eds.). The scientific basis of child custody decisions (pp. 120-156). New York: John Wiley

Ellis, E. (2000). Divorce Wars: Interventions with families in conflict. Washington, DC: American Psychological Association.

Gerard, (1994). Parent-Child Relationship Inventory (PCRI) manual. Los Angeles, CA: Western Psychological Services.

Heinze, M. & Grisso, T. (1996). Review of instruments assessing parenting competencies used in child custody determination. Behavioral Sciences and the Law, 14, 293-313.

Keilin, W., & Bloom, L. (1986). Child custody evaluation practices: A survey of experienced professionals. Professional Psychology: Research and Practice, 17, 338-346.

Teleki, J., Powell, J., and Dodder, R. (1982). Factor analysis of reports of parental behavior in children living in divorced and married families. Journal of Psychology, 112, 295- 302.

Wrightsman, L. (2005). Forensic Psychology. Belmont, CA: Wadsworth.

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Click here to return to Forensic Psychology Articles

Using Psychological Testing in Child Custody Evaluations

Child custody evaluations have evolved over the years. A shift has occurred from the ‘tender years doctrine,’ which presumed it was best for young children, and girls of any age, to be in the custody of their mother, to the ‘best interest of the child’ standard. With this newer standard, neither parent is believed to have an innate right to the child. The court must consider the mental and physical health of the parents and other individuals involved in childcare; the ability to provide food, clothing, medication, and other material benefits to the child; the interaction and relationship between the child and parent; and the wishes of the parents and child. This allows fathers greater access to the custody of their children. It also makes custody decisions more complicated and conflict laden.

Psychologists are therefore often asked to conduct child custody evaluations. Psychologists are encouraged to gather multiple data on parental capacity, the child’s adjustment, and the parent-child bond. Therefore, the child is interviewed alone and each parent is interviewed separately. Both parents are observed in a separate interaction with the child. Psychological testing is also often used to objectify the process. The most commonly used instruments are the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Rorschach Inkblot Test, Thematic Apperception Test (TAT), and Wechsler Adult Intelligence Scale (WAIS). However, more traditional tests such as these do not directly assess parenting skills. For example, while most psychologists, attorneys, and judges are familiar with these tests, they were not created to assess parenting capacity and are not directly related to the parent-child relationship.

The MMPI-2 assesses truthfulness, mental illness, and maladaptive personality traits, which are important factors in parenting. However, it should not be used as a standalone test as it does not directly assess how these traits impact the individual’s parenting. The Rorschach meets professional standards in the field but is highly controversial, has limited acceptability in court, and does not directly answer questions related to parenting. Therefore, if the MMPI-2 or Rorschach are used it should be to address the mental health of the parents and the data should be interpreted appropriately to reflect mental state rather than parental capacity. Intellectual capacity, as measured by the WAIS, has no direct bearing on parenting capacity unless there is a question of mental retardation. The TAT also has limited acceptability in court, has limited validity and reliability, and does not directly answer questions related to parenting.

Therefore, several tests have been developed to more directly gauge parenting. The Parent-Child Relationship Inventory (PCRI), Parenting Stress Index (PSI), and Children’s Reports of Parental Behavior (CRPB) are valid and reliable indicators of parental abilities.

The PCRI assesses the parent’s attitudes toward parenting and their children on domains of parental support, satisfaction with parenting, involvement, communication, limit setting, autonomy, and role orientation. Parents who implement discipline well have high scores and those who are referred for court-ordered mediation, and are at risk for child abuse, have low scores. The PSI identifies stressful factors within the child such as adaptability, demandingness, mood, distractibility/hyperactivity, and how acceptable and gratifying the child is to the parent. It also measures stressful factors in the parent’s life and interactions with the child such as depression, sense of competence, level of attachment to the child, spousal support, parental health, level of role restriction, and social interaction. The PSI appears to be a good predictor of which parent feels stressed by their child. The CRPB assesses a child’s perception of their parent’s warmth, acceptance of autonomy, limit setting, positive involvement, rejection, hostile control, intrusiveness, and inconsistent discipline. This is a good measure to help assess the child’s view of the situation that does not solely rely on questions they may have been prepped by their parent to answer.

Given that tests exist which more accurately assess parenting, it is suggested that data be gathered from such tests rather than purely from traditional tests. It is also expected that information will be gathered from alternative sources of information, such as interviews, observations, record review, and psychological testing will be used as a supplement to this information. Traditional tests should be used for their intended purposes only. When they are used, they should be used in conjunction with other materials and interpreted appropriately.

References:

Abidin, R. (1990). Parenting Stress Index (3^rd ed.). Odessa, FL: Psychological Assessment

Resources.

Allison, J. (1998). Review of the Parenting Stress Index. In J. Conoley & J. Imapara (Eds.),The twelfth mental measurements yearbook (pp.722-723). Lincoln: University of Nebraska Press.

 Bricklin, B. (1999). The contribution of psychological tests to child custody evaluations. In R. Galatzer-Levy & L. Kraus (Eds.). The scientific basis of child custody decisions (pp. 120-156). New York: John Wiley

Ellis, E. (2000). Divorce Wars: Interventions with families in conflict. Washington, DC: American Psychological Association.

Gerard, (1994). Parent-Child Relationship Inventory (PCRI) manual. Los Angeles, CA: Western Psychological Services.

Heinze, M. & Grisso, T. (1996). Review of instruments assessing parenting competencies used in child custody determination. Behavioral Sciences and the Law, 14, 293-313.

Keilin, W., & Bloom, L. (1986). Child custody evaluation practices: A survey of experienced professionals. Professional Psychology: Research and Practice, 17, 338-346.

Teleki, J., Powell, J., and Dodder, R. (1982). Factor analysis of reports of parental behavior in children living in divorced and married families. Journal of Psychology, 112, 295- 302.

Wrightsman, L. (2005). Forensic Psychology. Belmont, CA: Wadsworth.

Click here to download this article as a PDF
Click here to return to Forensic Psychology Articles