Case Study Adolescent W/Development Disability

Assessment 3:

Create and analyze a 1–2-page simulated case study of an adolescent with developmental challenges. Then, create a 5–7-page intervention plan based on evidence-based strategies that have proven effective in similar cases and make projections of possible long-term impacts that current challenges may produce across the individual’s lifespan.

To deepen your understanding, you are encouraged to consider the questions below and discuss them with a fellow learner, a work associate, an interested friend, or a member of the business community.

  • What      does the research say about the apparent inevitability of conflict between      parents and adolescents?
  • What      qualities will help a family lessen the conflict between parents and      adolescents?
  • What      does the research say about possible reasons behind adolescents’ behavior?
  • How      can you use your knowledge of adolescent behavior to work more effectively      with adolescents in your professional pursuit?
  • Should      juvenile offenders be treated differently from adults? Why or why not?
  • How      do ethnic and cultural factors affect adolescent identity development?
  • What      parenting practices can enhance adolescent social development?
  • What      are the roles of parents, siblings, and peers during this developmental      period?

Part 1: Create the Case: Adolescence

Create a simulated case study, relevant to your area of specialization, of an adolescent who presents developmental challenges related to Erikson’s age- or stage-related milestones expected at his or her age.

Your case study should be 1–2 pages in length and it should describe:

  • The      adolescent and his or her strengths and challenges.
  • A      challenge for the adolescent in terms of identity and self-concept.
  • The      medical, family, and social context.
  • The      developmental challenges evident in the behavior of the adolescent.
  • Evidence      in the case that the adolescent struggles by not meeting the expected      milestones of Erikson’s theory of adolescent development.
  • Individual      and cultural factors that theory and/or research indicate could impact the      adolescent’s development.
  • Any      other factors you deem appropriate based on your understanding of the      theory and related research.

To develop this case, you should:

  • Explore      theory and research related to development linked to adolescence.
  • Utilize      current research on adolescent brain development to describe potential      outcomes linked to brain development at this age, including important      considerations in the case you are developing.
  • Develop      your case study further by creating an environmental context for the      adolescent. Include any specific issues that you want to explore through      research, such as influences of a specific culture or ethnicity or specific      socioeconomic status.
  • Maintain      a resource list of the materials you consulted to build your case.

Follow current APA guidelines for style and formatting, as well as for citing your resources. Include a reference list of the scholarly resources you use.

Part 2: Adolescent Case Intervention Analysis

Research

Complete the following:

  • Research      evidence-based interventions that have been effective in meeting the      challenges of the adolescent you described in your case study, from the      perspective of your own professional specialization (as far as possible).
    • Explain       how the deficits in the social-emotional developmental domain impact       development.
    • Explain       how the environmental contexts impact development.
    • State       the recommended interventions that align with your specialization.
    • Include       evidence for those recommendations and outcomes from the professional       literature.
  • Explore      briefly the literature on adult identity and self-concept, considering      that early influences can impact development across the lifespan.
    • Explain,       from the perspective of your specialization, how the identity issues (for       example, Erikson’s theoretical perspective) that emerged in adolescence       could be manifested in adulthood.
    • Explain       how this might help in understanding and determining an approach to       working with an adult with a history of identity issues.

Structure of the Report

Use the following format to structure your report:

  • Title      page.
    • A       descriptive title of 5–15 words that concisely communicates the purpose       of your report and includes the name of the fictional subject. Be sure to       follow Capella’s suggested format for title pages on course papers.
  • Introduction.
    • An       overview of the paper contents, including a brief summary (approximately       ½ page) of the background information regarding the case study. (The       complete 1–2 page case you developed will be included as an appendix.)
  • Body      of the report.
    • The       presenting challenges and primary issues.
    • An       analysis of how lifespan development theory and research may account for       the presenting challenges.
    • An       assessment of the potential impact of individual and cultural differences       on development for the age and context described in the case study.
    • Suggestions       of evidence-based intervention strategies that have proven effective in       similar cases, supported by citations of research and any applicable       theories.
    • Projections,       based on research and/or theory, of possible long-term impacts that the       current challenges may produce across the individual’s lifespan.
  • Conclusion.
    • A       summary of what was introduced in the body of the paper with respect to       the case study context, challenges, and interventions.
  • Reference      page.
    • A       minimum of five scholarly sources from current peer-reviewed journals,       formatted in current APA style.

Other Requirements

Your paper should meet the following requirements:

· Written communication: Write coherently to support central ideas, in appropriate APA format, and with correct grammar, usage, and mechanics.

· Length of paper: 5–7 typed, double-spaced pages, not including the title page, reference page, or case study appendix.

· References: At least five scholarly sources (peer-reviewed journals).

· APA format: Follow current APA guidelines for style and formatting, as well as for citing your resources in the body of your paper and on the reference page.

· Font and font size: Times New Roman, 12 points.

Note: In graduate-level writing, you should minimize the use of direct quotes. Lengthy quotes do not count toward assessment minimums. It is your interpretation of the material and its application to practice that is assessed.

Operant Conditioning

Psychologists like B. F. Skinner have studied how we can use operant conditioning to change the behavior of people and animals. Drawing on your personal experience, choose a person or animal whose behavior you want to change. (You may select your own behavior for this question if you wish.) How could you use operant conditioning to change the behavior of this person or animal?

In a multi-paragraph essay, describe your plan to change this behavior. Be sure to mention what type of reinforcer and reinforcement schedule you would use and explain why you made those particular choices. Include information from class materials, readings, and research on operant conditioning to support your discussion.

What Is Operant Conditioning?

The discussion of behaviorism in Chapter 1 introduced you to Edward Thorndike and his law of effect. To recap, Thorndike had observed the learning that took place when a cat tried to escape one of his “puzzle boxes.” According to Thorndike, the cats learned to escape by repeating actions that produced desirable outcomes and by eliminating behaviors that produced what he called “annoying” outcomes, or outcomes featuring either no useful effects or negative effects (1913, p. 50). Consequently, the law of effect states that a behavior will be “stamped into” an organism’s repertoire depending on the consequences of the behavior (Thorndike, 1913, p. 129).

The association between a behavior and its consequences is called operant or instrumental conditioning. In this type of learning, organisms operate on their environment, and their behavior is often instrumental in producing an outcome. B. F. Skinner extended Thorndike’s findings using an apparatus that bears his name—the Skinner box, a modified cage containing levers or buttons that can be pressed or pecked by animals (see Figure 8.7).

The Skinner Box.

A specially adapted cage called a Skinner box, after behaviorist B. F. Skinner, allows researchers to investigate the results of reinforcement and punishment on the likelihood that the rat will press the bar.

 

 

Operant conditioning differs from classical conditioning along several dimensions. By definition, classical conditioning is based on an association between two stimuli, whereas operant conditioning occurs when a behavior is associated with its consequences. Classical conditioning generally works best with relatively involuntary behaviors, such as fear or salivation, whereas operant conditioning involves voluntary behaviors, like walking to class or waving to a friend.

8-4aTypes of Consequences

As we all know from experience, some types of consequences increase behaviors, while others decrease behaviors. Skinner divided consequences into four classes: positive reinforcement, negative reinforcement, positive punishment, and negative punishment. Both types of reinforcement increase their associated behaviors, whereas both types of punishment decrease associated behaviors (see Table 8.2).

Table 8.2

Types of Consequences

  Add stimulus to environment Remove stimulus from environment
Increase behavior Positive reinforcement Negative reinforcement
Decrease behavior Positive punishment Negative punishment

We all have unique sets of effective reinforcers and punishers. You might think that getting an A in a course is reinforcing, making all those extra hours spent studying worthwhile, but top grades may be less meaningful to the student sitting next to you, who came to college for the social life. A parent might spank a child, believing that spanking is an effective form of punishment, only to find that the child’s unwanted behavior is becoming more rather than less frequent. For some children, the reward of getting the parent’s attention overrides the discomfort of the spanking part of the interaction. In other words, the identity of a reinforcer or punisher is defined by its effects on behavior, not by some intrinsic quality of the consequence. The only accurate way to determine the impact of a consequence is to check your results. If you think you’re reinforcing or punishing a behavior but the frequency of the behavior is not changing in the direction you expect, try something else.

Positive Reinforcement

By definition, a positive reinforcement increases the frequency of its associated behavior by providing a desired outcome. Again, each person has a menu of effective reinforcements. In a common application of operant conditioning, children with autism spectrum disorder are taught language, with candy serving as the positive reinforcement. Benjamin Lahey tells of his experience trying to teach a child with autism spectrum disorder to say the syllable “ba” to obtain an M&M candy (Lahey, 1995). After 4 hours without progress, Lahey turned to the child’s mother in frustration, asking her what she thought might be the problem. The mother calmly replied that her son didn’t like M&Ms. Lahey switched to the child’s preferred treat, chopped carrots, and the child quickly began saying “ba.” Chopped carrots are probably not the first reinforcer you would try with a 4-year-old boy, but in this case, they made all the difference.

Thinking Scientifically

Why Do People Deliberately Injure Themselves?

Edward Thorndike’s Law of effect stipulates that behaviors followed by positive consequences are more likely to be repeated in the future, and that behaviors followed by negative consequences are less likely to be repeated. Why, then, do large numbers of people, particularly in adolescence, engage in self-injury, or deliberate physical damage without suicidal intent (Klonsky & Muehlenkamp, 2007)? Up to 25% of teens have tried self-injury at least once (Lovell & Clifford, 2016). Most initiate self-injury while in middle school (grades 6 through 8), and approximately 6% of college students continue to self-injure.

As this chapter has detailed, reward and punishment are in the eye of the beholder. The first challenge that we face in our analysis of self-injury is the assumption that pain is always a negative consequence. For most of us, it is. However, adolescents who engage in self-injury report feelings of relief or calm, despite the obvious pain that they inflict on themselves. Such feelings probably reinforce further bouts of self-injury. Self-injury often occurs in response to feelings of anger, anxiety, and frustration, and alleviation of these negative feelings might reward the injurious behavior (Klonsky, 2007; Klonsky & Muehlenkamp, 2007). Finally, injury is associated with the release of endorphins, our bodies’ natural opioids. The positive feelings associated with endorphin release also might reinforce the behavior.

Self-injury frequently occurs in people diagnosed with psychological disorders, such as depression, anxiety disorders, eating disorders, or substance abuse, which are discussed further in Chapters 7 and 14. Others engaging in the behavior have a history of sexual abuse. Observations that captive animals in zoos and laboratories are often prone to self-injury might provide additional insight into the causes of this behavior (Jones & Barraclough, 1978). Treatment usually consists of therapy for any underlying psychological disorders, along with avoidance, in which the person is encouraged to engage in behaviors that are incompatible with self-harm. To assist these individuals further, we need to be able to see reward and punishment from their perspective, not just our own.

If the consequences of a behavior influence how likely a person is to repeat the behavior in the future, how can we explain the prevalence of self-injury? Why don’t the painful consequences of the behavior make people stop? In situations like this, operant conditioning tells us that we need to look for possible reinforcers for the behavior that override the painful outcomes. In the case of self-injury, people report feeling calm and relief. To treat such behaviors effectively, psychologists need to understand what advantages they provide from the perspective of the person doing the behavior.

 

Rusig/Alamy Stock Photo

The Premack principle can help you maintain good time management. If you prefer socializing to studying, use the opportunity to socialize as a reward for meeting your evening’s study goals.

If everyone has a different set of effective reinforcers, how do we know which to use? A simple technique for predicting what a particular animal or person will find reinforcing is the Premack principle, which states that whatever behavior an organism spends the most time and energy doing is likely to be important to that organism (Premack, 1965). It is possible, therefore, to rank people’s free-time activities according to their priorities. If Lahey had been able to observe his young client’s eating habits before starting training, it is unlikely that he would have made the mistake of offering M&Ms as reinforcers. The opportunity to engage in a higher-priority activity is always capable of rewarding a lower-priority activity. Your grandmother may never have heard of Premack, but she knows that telling you to eat your broccoli to get an ice cream generally works.

Both Thorndike and Skinner agreed that positive reinforcement is a powerful tool for managing behavior. In our later discussion of punishment, we will argue that the effects of positive reinforcement are more powerful than the effects of punishment. Unfortunately, in Western culture, we tend to provide relatively little positive reinforcement. We are more likely to hear about our mistakes from our boss than all the things we’ve done correctly. It is possible that we feel entitled to good treatment from others, so we feel that we should not have to provide any reward for reasonably expected behaviors. The problem with this approach is that extinction occurs in operant, as well as in classical, conditioning. A behavior that is no longer reinforced drops in frequency. By ignoring other people’s desirable behaviors instead of reinforcing them, perhaps with a simple thank-you, we risk reducing their frequency.

According to the Premack principle, a preferred activity can be used to reinforce a less preferred activity. Most children prefer candy over carrots, so rewarding a child with candy for eating carrots often increases carrot consumption. One little boy with autism spectrum disorder, however, preferred carrots to M&Ms, and his training proceeded more smoothly when carrot rewards were substituted for candy rewards.

 

 

Carolyn Jenkins/Alamy Stock Photo; Itani/Alamy Stock Photo

Some reinforcers, known as primary reinforcers, are effective because of their natural roles in survival, such as food. Others must be learned. We are not born valuing money, grades, or gold medals. These are examples of  conditioned reinforcers , also called secondary reinforcers, that gain their value and ability to influence behavior from being associated with other things we value. Here, we see an intersection between classical and operant conditioning. If you always say “good dog” before you provide your pet with a treat, saying “good dog” becomes a CS for food (the UCS) that can now be used to reinforce compliance with commands to come, sit, or heel (operant behaviors). Classical conditioning establishes the value of “good dog,” and operant conditioning describes the use of “good dog” to reinforce the dog’s voluntary behavior.

Serena Williams “loves” her Wimbledon trophy not for its intrinsic value (you can’t eat it, etc.), but because trophies have become conditioned reinforcers.

 

PA Images/Alamy Stock Photo

Many superstitious behaviors, like wearing your “lucky socks,” can be learned through operant conditioning. Operant conditioning does not require a behavior to cause a positive outcome to be strengthened. All that is required is that a behavior be followed by a positive outcome. Unless you suddenly have a string of bad performances while wearing the lucky socks, you are unlikely to have an opportunity to unlearn your superstition.

Humans are capable of generating long chains of conditioned reinforcers extending far into the future. We might ask you why you are studying this textbook right now, at this moment. A psychologist might answer that you are studying now because studying will be reinforced by a good grade at the end of the term, which in turn will be reinforced by a diploma at the end of your college education, which in turn will be reinforced by a good job after graduation, which in turn will be reinforced by a good salary, which will allow you to live in a nice house, drive a nice car, wear nice clothes, eat good food, and provide the same for your family in the coming years.

Negative Reinforcement

Negative reinforcement , which sounds contradictory, involves the removal of unpleasant consequences from a situation to increase the frequency of an associated behavior. Negative reinforcement increases the frequency of behaviors that allow an organism to avoid, turn off, or postpone an unpleasant consequence; these are sometimes called escape and avoidance behaviors.

Let’s look at a laboratory example of negative reinforcement before tackling real-world examples. If a hungry rat in a Skinner box learns that pressing a bar produces food, a positive consequence, we would expect the frequency of bar pressing to increase. This would be an instance of positive reinforcement. However, if pressing the bar turns off or delays the administration of an electric shock, we would still expect the frequency of bar pressing to increase. This would be an instance of negative reinforcement.

Be careful to avoid confusing negative reinforcement with punishment, which is covered in the next section. By definition, a punishment decreases the frequency of the behaviors that it follows, whereas both positive and negative reinforcers increase the frequency of the behaviors that they follow. Returning to our Skinner box example, the rat’s bar pressing increases following both positive reinforcement (food) and negative reinforcement (turning off a shock). If we shocked the rat every time it pressed the bar (punishment), it would stop pressing the bar quickly.

Many everyday behaviors are maintained by negative reinforcement. We buckle up in our cars to turn off annoying beeps or bells, open umbrellas to avoid getting wet, scratch an insect bite to relieve the itch, take an aspirin to escape a headache, apply sunscreen to avoid a sunburn or skin cancer, and apologize to avoid further misunderstandings with a friend.

In many real-world cases, positive and negative reinforcement act on behavior simultaneously. A heroin addict uses the drug to obtain a state of euphoria (positive reinforcer) but also to eliminate the unpleasant symptoms of withdrawal (negative reinforcer). You might study hard to achieve high grades (positive reinforcers) while also being motivated by the need to avoid low grades (negative reinforcers).

Punishment

 punishment  is any consequence that reduces the frequency of an associated behavior.  Positive punishment  refers to applying an aversive consequence that reduces the frequency of or eliminates a behavior. As described previously, we can demonstrate that a rat will quickly stop pressing a bar if each press results in an electric shock.  Negative punishment involves the removal of something desirable. In the Skinner box, we can change the rules for a rat that has learned previously to press a bar for food. Now, food is made available unless the rat presses the bar. Under these conditions, the rat will also quickly stop pressing the bar.

Putting up an umbrella to avoid getting wet from the rain is an example of a negatively reinforced behavior.

 

Greg McWilliams/Icon SMI 408/Newscom/Icon Sportswire/Atlanta Ga United States

Thorndike and Skinner were in agreement about the relative weakness of punishment as a means of controlling behavior. Part of the weakness of punishment effects arises from the difficulties of applying punishment effectively in real contexts. Three conditions must be met for punishment to have observable effects on behavior: significance, immediacy, and consistency (Schwartz, 1984).

As we observed with reinforcement, consequences have to matter to the person or animal receiving them (i.e., significance). If we use a punisher that is too mild for a particular individual, there is little incentive for that person to change behavior. College campuses usually charge a fairly significant amount of money for parking illegally. However, there will typically be some students for whom that particular punishment is not sufficient to ensure that they will park legally. How high would a parking fee have to be to gain complete compliance on the part of the university community? What if you risked the death penalty for parking illegally? We can be fairly certain that most people would leave their cars at home rather than risk that particular consequence. The point is that punishment can work if a sufficiently severe consequence is selected, but using the amount of force needed to produce results is rarely considered practical and ethical. Free societies have long-standing social prohibitions against cruel and unusual punishments, and these conventions are incompatible with using the force that may be needed to change the behavior of some individuals.

Immediate punishment is more effective than delayed punishment (i.e., immediacy). For the rat in the Skinner box, delays of just 10 seconds can reduce the effectiveness of electric shock as a punisher. Humans are more capable than rats at bridging long intervals (Kamin, 1959). Nonetheless, the same principle holds true. Delayed punishment is less effective than immediate punishment. We should not be too surprised that the months or years that are required to try and convict a serious criminal may greatly reduce the impact of imprisonment on that person’s subsequent behavior.

The likelihood of getting a ticket influences drivers’ behavior. At an intersection with cameras, drivers are unlikely to run a red light, but at other intersections, behavior might be determined by whether a police officer is nearby.

 

Ernest R. Prim/Shutterstock.com

Our final requirement for effective punishment is its uniform application (i.e., consistency). College students are a prosocial, law-abiding group as a whole, yet many confess to determining their highway speed based on the presence or absence of a police car in their rearview mirrors. The experience of exceeding the speed limit without consequence weakens the ability of the possibility of tickets and fines to influence behavior. However, at intersections known to be controlled by cameras, compliance is generally quite high. If you are certain that running a red light will result in an expensive ticket, it would be foolish to test the system.

To reduce undesirable behaviors, Skinner recommended extinction as an alternative to punishment (Skinner, 1953). In the discussion of classical conditioning earlier in this chapter,the term extinction was used to refer to the disappearance of CRs that occurs when the CS no longer signals the arrival of a UCS. Extinction in operant conditioning has a similar meaning. Learned behaviors stop when they are no longer followed by a reinforcing consequence. Attention is a powerful reinforcer for humans, and ignoring negative behavior should extinguish it. Parents and teachers cannot look the other way when one child is being physically aggressive toward another, but in many other instances, Skinner’s approach is quite successful in reducing the frequency of unwanted behaviors (Brown & Elliot, 1965). Although ignoring a child’s tantrums can be embarrassing for many parents, this can be an effective strategy for reducing their frequency.

Connecting to Research

Does Age Influence the Effects of Consequences?

In this chapter, we have learned that rewards increase and punishments decrease the frequency of associated behaviors. But how do these consequences compare to each other? Do people learn faster when rewarded or punished? Is the relative effectiveness of reward and punishment the same for people of all ages? Participants were asked to choose the “correct” item from a pair of abstract symbols, and that their overall points (11 for a correct choice and 21 for an incorrect choice) would determine a final monetary prize (Palminteri, Kilford, Coricelli, & Blakemore, 2016).

The Question: Do adolescents and adults respond differently to consequences?

Methods

In this British study, 38 people (20 adults between the ages of 18 and 32 and 18 adolescents between the ages of 12 and 17) participated. They received 5 pounds (about $6.20) for participating, plus anywhere from zero to 10 pounds ($12.40) based on their performance in the task. They viewed pairs of abstract items (the Agathodaimon alphabet). As shown in Figure 8.8, their choices were either rewarded (happy smiley and +1 point) or punished (unhappy smiley and −1 point).

Figure 8.8Research Protocol for Studying the Effects of Reward and Punishment.

Participants viewed these slides in order. First, they fixated on the cross. Next, they see both figures and select one. Finally, they receive feedback in the form of a smiley and point total (in this case, our participant was correct).

 

Source: S. Palminteri, E. J. Kilford, G. Coricelli, & S.-J. Blakemore (2016). “The Computational Development of Reinforcement Learning During Adolescence.” PLoS Computational Biology, 12(6), e1004953.

Ethics

Although the topic of punishment might make it sound like this study raises more than the typical ethical concerns about research, facing an unhappy smiley and failing to earn 10 pounds ($12.40) are unlikely to cause the participants significant distress. The “risks” of the study would be spelled out for prospective participants in an informed consent process. The participation of adolescents would require parent or guardian approval plus participant assent. In other words, adolescents can’t be forced to participate by their parents, but they cannot participate without parental approval.

Results

The adults learned equally well from punishment and reinforcement. In contrast, the adolescents were more likely to learn from reinforcement than from punishment. In other words, the adolescents were more likely to seek rewards than to try to avoid punishments.

Conclusions

This research demonstrated that decision making based on the probabilities of reward and punishment continues to develop through adolescence into young adulthood. Unlike the adults, who were as likely to seek rewards as they were to try to avoid punishments, the adolescents appeared to pay more attention to rewards.

Among the many implications of this study, we might conclude that using positive feedback to support learning in adolescents is likely to produce more benefits that using negative feedback. In other words, teens might learn more at school about what they’re doing correctly than what they’re doing incorrectly. College students, in contrast, are likely to benefit from both types of feedback.

8-4bSchedules of Reinforcement

Reinforcing a behavior every time it occurs is known as continuous reinforcement. Although it is highly desirable to use continuous reinforcement when a new behavior is being learned, it is inconvenient to do so forever. Dog owners want their dogs to walk with a loose leash, but once this skill is learned, the owners don’t want to carry dog treats for reinforcement whenever they walk their dogs. Once we deviate from continuous reinforcement, however, the manner in which we do so may have a dramatic impact on the target behavior. To obtain the results we want, it is helpful to understand what happens when we use  partial reinforcement , or the reinforcement of the desired behavior on some occasions, but not others.

Concerns about the effects of piecework on worker well-being contributed to the Fair Labor Standards Act of 1938, which included a provision for a minimum hourly wage.

Psychologists have identified many ways to apply partial reinforcement, but we will concentrate on two variations: ratio schedules and interval schedules. In a ratio schedule of partial reinforcement, reinforcement depends on the number of times a behavior occurs. In an interval schedule of partial reinforcement, reinforcement depends on the passage of a certain amount of time. Either type of schedule, ratio or interval, can be fixed or variable. In fixed schedules, the requirements for reinforcement never vary. In variable schedules, the requirements for reinforcement are allowed to fluctuate from trial to trial, averaging a certain amount over the course of a learning session.

Fixed Ratio Schedules

 fixed ratio (FR) schedule  requires that a behavior occur a set number of times for each reinforcer. Continuous reinforcement, discussed earlier, is equivalent to a FR of 1. If we now raise our requirement to two behaviors per reinforcer, we have a FR schedule of 2, and so on. Using the Skinner box, we can investigate the influence of FR schedules on the rate at which a rat will press a bar for food. To do so, we track cumulative responses as a function of time. FR schedules produce a characteristic pattern of responding. In general, responses are fairly steady, with a significant pause following each reward. As the amount of work for each reward is increased, responding becomes slower (see Figure 8.9).

Figure 8.9Schedules of Reinforcement.

The schedule used to deliver reinforcement has a big impact on the resulting behavior. In general, the variable schedules produce higher rates of responding than do their fixed counterparts. The fixed interval schedule produces a characteristic pattern of low rates of responding at the beginning of the interval and accelerated responding as the end of the interval approaches.

 

Diverse Voices in Psychology

Does Physical Punishment Have Different Effects in Different Cultural Contexts?

Psychologists typically recommend against the use of physical punishment with children, largely due to research showing a relationship between the use of physical punishment and increased aggressiveness on the part of a child. In addition, as you have seen in this chapter, there are many alternative ways to manage behavior successfully.

As is the case with many types of psychological research, however, the classic studies on physical punishment and child aggression were conducted with middle-class, white American families. How representative are these samples of families in general? Some researchers believe that they are not representative and that physical punishment effects depend very much on cultural context (Deater-Deckard & Dodge, 1997). These researchers believe that physical punishment in cultures in which it is considered “normal” has a much less detrimental effect than in cultures where it is considered less normal.

Racial and ethnic groups vary in the frequency with which they use physical punishment (Gershoff, Lansford, Sexton, Davis-Kean, & Sameroff, 2012). In a sample of over 11,000 U.S. families with kindergarten-aged children, rates of spanking were generally high (about 80%) across all groups, with 89% of African Americans, 79% of whites, 80% of Hispanics, and 73% of Asians reporting having spanked their child. When asked if they had spanked their child in the previous week, 40% of African Americans, 28% of Hispanics, 24% of whites, and 23% of Asians reported that they had done so.

Does spanking have different effects on children’s behavior across the racial and ethnic groups due to these different frequencies? Gershoff et al. (2012) concluded that it does not. Across all racial and ethnic groups, spanking was associated with higher levels of aggressive behaviors in the child, which in turn leads to more spanking in a “coercive cycle” of parenting.

Psychologists have wondered if spanking had different effects within different racial and ethnic contexts, but it does not. Spanking is associated with higher levels of child aggression, regardless of racial or ethnic context.

 

Sandro Di Carlo Darsa/PhotoAlto/Alamy Stock Photo

While many lines of research benefit from considerations of diversity, the message here is not modified by racial or ethnic identity—spanking children not only fails to decrease negative behaviors, but it actually appears to increase them.

In early industrial settings, workers were often paid by the piece, a real-world example of the use of an FR schedule. In other words, workers would be paid every time they produced a fixed number of products or parts on an assembly line. Most workers find this system less than ideal. If the equipment malfunctions, the worker cannot earn money. Lunch breaks would also then be viewed as loss of income rather than a helpful time of rest. Some examples of piecework remain today, including the work of most physicians, who get paid by the procedure, and service workers like plumbers or hairstylists, who get paid for finishing a specific task.

Variable Ratio Schedules

As in FR schedules,  variable ratio (VR) schedules  also involve counting the number of times that a behavior occurs. However, this time the required number of behaviors is allowed to fluctuate around some average amount.

In the Skinner box, we might set our VR schedule to 10 for a 1-hour session. This means that over the course of the session, the rat must press an average of 10 times to receive each food pellet. However, this schedule may mean that only 1 press delivers food on one trial, but 30 presses are required on the next trial. The rat is unable to predict when reinforcement is likely to occur, leading to a high, steady rate of responding in our cumulative record. We do not see the characteristic pausing observed following reinforcement in the FR schedule because the rat cannot predict when the next reward will occur.

One of the most dramatic real-world examples of the VR schedule is the programming of slot machines in casinos. Slot machines are human versions of Skinner boxes that use VR schedules. The casino sets the machine to pay off after some average number of plays, but the player doesn’t know whether a payoff will occur after one coin or thousands are inserted. You don’t have to observe the behavior of people playing slot machines long to see a demonstration of the high, steady responding that characterizes the VR schedule. The programming of slot machines can be sophisticated. Slot machines that are located in places where people are unlikely to return (airports and bus stations) pay off less frequently than those in places where people are more likely to play regularly.

Fixed Interval Schedules

Unlike ratio schedules, reinforcement in interval schedules depends on the passage of time rather than the number of responses produced. In a  fixed interval (FI) schedule , the time that must pass before reinforcement becomes available following a single response is set to a certain amount. In the Skinner box, a rat’s first bar press starts a timer. Responses that occur before the timer counts down are not reinforced. As soon as the timer counts down to zero, the rat’s next bar press is reinforced, and the timer starts counting down again. In the FI schedule, the interval is the same from trial to trial. Animals and people have a good general sense of the passage of time, leading to a characteristic pattern of responding in FI situations. Reinforcement is followed by a long pause. As the end of the interval is anticipated, responding increases sharply. A graph of the number of bills passed by the U.S. Congress as a function of time looks similar to the rat’s performance on an FI schedule in the Skinner box (Weisberg & Waldrop, 1972). Few bills are passed at the beginning of a session, but many are passed at the end (see Figure 8.10).

Workers in the garment industry are often paid by the piece, or with a set amount of money for each finished garment. This compensation system is an example of a fixed ratio (FR) schedule. Because workers cannot make money when their equipment breaks down and they tend to view lunch and other breaks as costing them money, this schedule is not considered to be fair to workers.

 

SCPhotos/Alamy Stock Photo

Figure 8.10Congress and Fixed Interval (FI) Behavior.

As the end of a congressional session approaches, the U.S. Congress begins to pass more bills in patterns that look similar to the behavior of rats on FI schedules in Skinner boxes.

 

Library of Congress Prints and Photographs Division [LC-HS503-1388]

Variable Interval Schedules

As you already may have guessed, the  variable interval (VI) schedule  is characterized by an interval that is allowed to fluctuate around some average amount over the course of a session. This time, our bar-pressing rat experiences intervals that range around some average amount (say, 2 minutes). On one trial, the rat may obtain reinforcement after only 30 seconds, whereas the next trial may involve an interval of 5 minutes. Over the session, the average of all intervals is 2 minutes. As in the VR situation, we see a high, steady rate of responding.

You are probably quite familiar with VI schedules, in the form of pop quizzes administered by your professors. Your professor might tell you that there will be five quizzes given during the term, but the timing of the quizzes remains a surprise. You might have the first two only 1 day apart, followed by a 2-week interval before the next quiz. Your best strategy, like the rat in the Skinner box on a VI schedule, is to emit a high, steady rate of behavior.

Partial Reinforcement Effect in Extinction

Many parents have regretted the day that they unintentionally put an unwanted behavior on a partial reinforcement schedule by uttering the words, “OK, just this once.” Perhaps a parent is strongly opposed to buying candy for a child at the supermarket checkout counter (where, because of John Watson and his applications of psychology to advertising, candy is displayed conveniently at child’s-eye height). Then comes the fateful day when the parent is late coming home from work, the child is hungry because dinner is delayed, and unintentionally, the parent gives in “just this once,” putting begging for candy on a variable schedule. Subsequently, when the parent returns to the previous refusal to buy candy, a high, steady rate of begging behavior occurs before it finally extinguishes.

Most casinos feature a large number of slot machines, which are essentially Skinner boxes for people. The slot machine is programmed on a variable ratio (VR) schedule, which means that the player cannot predict how many plays it will take to win. In response, players exhibit the same high, steady rate of responding that we observe in rats working on VR schedules in the laboratory.

 

Tetra Images/Photoshot

In the laboratory once more, we compare the behavior of two rats in Skinner boxes. One is working on a continuous (or FR 1) schedule of reinforcement. The other is working on a partial schedule of reinforcement (perhaps a VR 3 schedule). After several sessions of training, we stop reinforcement for both rats. It may surprise you to learn that the rat working on the continuous schedule will stop pressing long before the rat accustomed to the VR 3 schedule. In other words, extinction occurs more rapidly following continuous reinforcement than following partial schedules. This outcome is known as the  partial reinforcement effect in extinction .

The partial reinforcement effect probably occurs because of one of two factors, or a combination of both. First, the transition from continuous reinforcement to extinction is more obvious than the transition from a partial schedule to extinction. If you are accustomed to being paid for a babysitting job every time you work, you will definitely notice any of your employer’s failures to pay. In contrast, if your neighbor typically pays you about once a month for raking his yard each weekend, you might not notice right away that he hasn’t paid you for a while. Second, partial schedules teach organisms to persist in the face of nonreinforcement. In a sense, partial schedules teach us to work through periods in which reinforcement does not occur. Consequently, we might view extinction as just another case where continuing to perform might eventually produce reinforcement. When positive behavior is occurring, such as working on your senior thesis regularly despite a much-delayed grade, persistence is an enormous advantage. However, as shown in our earlier example of begging for candy, placing an undesirable behavior on partial reinforcement makes it more difficult to extinguish.

Fishing works according to a variable interval (VI) schedule of reinforcement. Fish (the reinforcers) are caught after periods of waiting for fish to bite that vary in length. As in laboratory demonstrations of the VI schedule, fishing usually produces a steady rate of responding.

 

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Comparing Schedules

What happens if you are exposed to two or more schedules of reinforcement at the same time? This scenario is realistic because we face these types of choices every day. Which is a more rewarding use of my time: studying for my midterm or making some extra money by working overtime? In making these types of choices, animals and people follow the matching law, which states that the relative frequency of responding to one alternative will match the relative reinforcement for responses on that alternative (Herrnstein & Heyman, 1979). The law powerfully accounts for the effects on behavior of frequency, magnitude, and delays in reward.

Time spent playing online video games provides an interesting example of the effects of simultaneous schedules of reinforcement. The millions of users of massively multiplayer online games, such as League of Legends and Crossfire, spend an average of 22 hours per week on their games (Yee, 2006). What compels these people to make such a lopsided choice between online interactions and real-life social experiences? One clue to this choice is that substantial numbers of players report that “the most rewarding or satisfying experience” they had over the last 7 or 30 days took place while gaming. We would assume that if the frequency and magnitude of rewards available in gaming were higher than those in real-life socializing, people would choose to spend their time accordingly.

8-4cThe Method of Successive Approximations (Shaping)

So far, this discussion of operant conditioning has centered on increasing or decreasing the frequency of a particular behavior. What happens if you want to increase the frequency of a behavior that rarely or never occurs? Most parents would like to teach their children to use good table manners, but you could wait a long time for the opportunity to reward young children for using the correct utensil to eat their food.

Fortunately, we have a method for increasing the frequency of behaviors that never or rarely occur. Using the  method of successive approximations , or shaping, we begin by reinforcing spontaneous behaviors that are somewhat similar to the target behavior that we want to train. As training continues, we use gradually more stringent requirements for reinforcement until the exact behavior that we want occurs. You can think of shaping as a funnel. Using the table manners example, parents start out with generous criteria for reinforcement (“Thank you for picking up the spoon”) and gradually narrow the criteria (“Thank you for putting the spoon in the food”) until they are reinforcing only the target behavior (“Thank you for using the spoon to eat your applesauce”). One of the most positive features about the shaping process is that behavior doesn’t have to be perfect to produce reinforcement.

Whether training imaginary raptors in Jurassic World or real animals, using the method of successive approximations (shaping) can lead to the reliable performance of otherwise low-frequency behaviors. Like Chris Pratt’s character, most trainers use a combination of classical conditioning (clicker sound leads to food) and operant conditioning (approximation of desired behavior leads to clicker sound).

 

Pictorial Press Ltd/Alamy Stock Photo

The rats in Skinner boxes that have been described in this chapter do not spontaneously start pressing levers. We have to teach them to do so. We begin by making sure the hungry rat understands that food is available in the Skinner box. Using a remote control, we activate the food dispenser a few times. Quickly, the rat forms a classically conditioned association between the sound of the food dispenser (CS) and the arrival of food (UCS) in the cup. However, if we continue to feed the rat in this manner, it is unlikely that it will ever learn to press the bar. Indeed, there is no reason for it to do so because it already is obtaining the food it needs. So, we narrow our criteria for obtaining food from simply existing in the box to standing in the corner of the box that contains the bar. If we press our remote control every time the rat is in the correct corner, it will begin to stay there most of the time. Now we want the rat to rear on its back feet so that it is likely to hit the bar with its front feet on the way down. If we begin to reinforce the rat less frequently for staying in the corner, it will begin to explore. Eventually, the rat is likely to hit the bar with its front feet while exploring, pressing the bar. Now it will begin to press the bar on its own. In the hands of an experienced trainer, this process takes about half an hour.

Shaping involves a delicate tightrope walk between too much and too little reinforcement. If we reinforce too generously, learning stops because there is no incentive for change. If your piano teacher always tells you that your performances are perfect, you will stop trying to improve them. However, if we don’t reinforce frequently enough, the learner becomes discouraged. Reinforcement provides important feedback to the learner, so insufficient reinforcement may slow or stop the learning process.

Teaching a complex behavior requires chaining, or breaking down the behavior into manageable steps. Chaining can be done in a forward direction, such as teaching the letters of the alphabet from A to Z, or in a backward direction, such as teaching the last step in a sequence, then the next to the last, and so on. Chaining can be useful when teaching new skills, such as working independently on academic projects, to children with special needs (Pelios, MacDuff, & Axelrod, 2003). Backward chaining is used by most trainers of animals used in entertainment. For example, dogs have been taught to perform complex dances like the Macarena (Burch & Bailey, 1999). The trainer uses a verbal, gestural, or clicker cue while shaping the last step in the dance. When the dog performs this last step reliably, the trainer adds the next-to-last step, and so on until the entire complex sequence is mastered.

8-4dCognitive, Biological, and Social Influences on Operant Conditioning

Even the most radical behaviorists, including Skinner, did not deny the existence of cognitive, social, or biological influences on learning (Jensen & Burgess, 1997). Instead, behaviorists believed that internal processes followed the same rules as externally observable behavior. As Skinner (1953) wrote, “We need not suppose that events which take place within an organism’s skin have special properties…. A private event may be distinguished by its limited accessibility but not, so far as we know, by any special nature or structure” (p. 257). However, as we saw in the case of classical conditioning, the results of some operant conditioning experiments stimulated greater interest in the cognitive, social, and biological processes involved in learning.

Cognitive Influences on Operant Conditioning

One of the important principles of operant conditioning is that consequences are required in order for learning to occur. Edward Tolman (1948) challenged this notion by allowing his rats to explore mazes without food reinforcement. Subsequently, when food was placed in the goal boxes of the mazes, the previously unreinforced rats performed as well as the rats that had been reinforced all along. Tolman referred to the rats’ ability to learn in the absence of reinforcement as  latent learning . He argued that the rats had learned while just exploring, but that they did not demonstrate their learning until motivated by the food reward to do so. We usually judge whether learning has occurred by observing outward behavior. Tolman’s rats remind us that there is a difference between what has been learned and what is performed. Students are all too familiar with the experience of performing poorly on exams despite having learned a great deal about the material.

In addition to challenging the role of reinforcement in learning, Tolman disputed traditional behaviorist explanations of the nature of the learning that occurred in mazes. He believed that instead of learning a simple operant “turn right for food” association, rats learned “This is where I can find food” (Tolman, 1948, 1959). After training rats to follow a path in a maze to find food, Tolman blocked the path but allowed the rats to choose from a number of additional paths. If the rats had learned a simple turn left–get food response, they should have chosen the paths that were most similar to the training path. Instead, they showed evidence of choosing paths that required them to turn in a different direction from their previously trained path, but one that led them directly to the goal (Tolman, Richie, & Kalish, 1946; see Figure 8.11).

Figure 8.11Tolman’s Maze.

Edward Tolman did not believe that rats wandering around a maze learned “turn left for food” in the way that early behaviorists believed that they did. Instead, Tolman believed that the rats were learning a more cognitive map of where they could find food. He provided evidence for his approach by blocking a learned pathway to food. If the behaviorists were right, the rats should choose the path most similar to the trained one. However, the rats did not do that. They showed evidence of having formed cognitive maps and were willing to turn in a different direction if that path led to food.

 

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To account for his results, Tolman suggested that the rats had formed cognitive maps, or mental representations of the mazes. Map formation was viewed as a unique, nonassociative learning process that didn’t follow the previously established rules of associative learning (O’Keefe & Nadel, 1978). For example, in contrast to the gradual acquisition of learning that usually occurs in classical and operant conditioning, cognitive maps are instantly updated when new information becomes available.

Chimpanzees show considerable ability to form cognitive maps (Menzel, 1978). After being carried around a circuitous route in their one-acre compound as nine vegetables and nine fruits were placed in 18 locations, chimpanzees were released in the center of the compound. They not only navigated to each food location using the shortest pathways, but, given their preference for fruit over vegetables, they visited the spots containing fruit first. They showed no indication that they were attempting to retrace the pathway over which they were carried as the food was put in place.

Biological Influences on Operant Conditioning

Just as the work of Garcia and Koelling highlighted the need to consider biological limitations on classical conditioning, biological boundaries in operant conditioning were described by Keller and Marion Breland, two of Skinner’s former students. In their 1961 article titled “The Misbehavior of Organisms” (a wordplay on Skinner’s classic book, The Behavior of Organisms), the Brelands outlined some challenges they encountered while using operant conditioning to train animals for entertainment.

In one instance, the researchers described how they sought to train a pig to pick up large wooden coins and deposit the coins in a large, wooden “piggy bank.” Initially, all went well. The pig would quickly learn to deposit four or five coins (an example of an FR schedule) for each food reward. Eventually, however, the pig began to work slower and slower, to the point where it couldn’t obtain enough food for the day. Instead of taking the coins to the piggy bank, the pig would repeatedly toss them in the air and sniff around to find them. Raccoons trained with the coins ultimately tried to wash them instead of depositing them in the bank. The animals’ natural approach to food (the rooting by the pigs and the washing by the raccoons) began to interfere with their handling of the coins. You may already have suspected that the coins had become the object of some higher-order classical conditioning because of their relationship with food. The Brelands concluded “that these animals are trapped by strong instinctive behaviors, and clearly we have here a demonstration of the prepotency of such behavior patterns over those which have been conditioned. We have termed this phenomenon ‘instinctive drift’” (Breland & Breland, 1961, p. 683).

Keller Breland observes the performance of one of the star pupils of the I.Q. Zoo attraction he developed with his wife, Marian. Unfortunately, the Brelands discovered that the animals’ instinctive behaviors often interfered with their training. The Brelands referred to this phenomenon as “instinctive drift.”

 

Historical/Corbis

Social Influences on Operant Conditioning

So far, this discussion of classical and operant conditioning has focused on the individual in isolation. Learning can take place when people or animals are alone, but it often occurs in the presence of others, especially in a species as social as ours. As we will see in a later section, people are particularly likely to learn by observing others. What do we know about the impact of others on our operant learning?

The presence of others may not just promote learning; it also may be necessary for learning. Human infants learn more about language when they are listening to another person face to face than when they are watching a person speak on television (Kuhl, 2007; Meltzoff, Kuhl, Movellan, & Sejnowski, 2009). Although operant conditioning alone cannot account for language learning, as discussed in Chapters 10 and 11, these results emphasize the importance of social interaction in producing the arousal, focus, and motivation that contribute to effective learning.

Experienced whale trainer Dawn Brancheau was killed by one of her favorite killer whales during a 2010 show at Sea World in Orlando, Florida. Animal experts believed that the whale had simply reverted to normal whale behavior, similar to the instinctive drift observed by Keller and Marian Breland.

 

Orlando Sentinel/Getty Images

As mentioned previously in the discussion of cognitive maps, learning and the performance of learned behavior are not always identical. Our performance of learned behaviors varies depending on an interaction between the presence of others and the complexity of the learned task. For simple tasks, like pedaling a bicycle or reeling in a fishing line, the presence of others makes us perform faster, a phenomenon known as social facilitation (Triplett, 1898; also see Chapter 13). In complex tasks, such as taking a difficult college entrance exam, the presence of others can make our performance slower and poorer. Again, this effect is not restricted to complex organisms like ourselves; the same results can be observed in the lowly cockroach (Zajonc, 1965). In a straight maze leading to food, cockroaches with an audience of other cockroaches ran quickly. In a more complex maze involving several turns, the cockroaches responded to an audience by running more slowly.

8-4eApplying Operant Conditioning

Important applications of operant conditioning may be found in contemporary approaches to psychotherapy, education, advertising, politics, and many other domains.

Possibly one of the oddest applications of operant conditioning was Skinner’s secret World War II defense project, code-named Project Pigeon. Lagging well behind the Nazis in the area of guided missile technology, the United States invested $25,000 (worth about $400,000 in today’s dollars) in Skinner’s “organic homing device” (Capshew, 1993). Skinner, who had considerable experience training pigeons to peck at visual stimuli in his laboratory, now trained them to peck at a projected image of a missile’s target. Riding in a chamber within the missile, the pigeon’s pecks would be translated into updated commands for correcting the path of the bomb. Unfortunately for Skinner (but fortunately for his pigeons), Project Pigeon elicited laughter from military officers instead of approval (Skinner, 1960). Although never implemented, Project Pigeon stimulated Skinner and his intellectual descendents to look outside the laboratory for useful extensions of their work on learning.

B. F. Skinner’s Project Pigeon was one of the more bizarre applications of operant conditioning research. Pigeons enclosed in this capsule were trained to peck at projected images of bomb targets. Even though Skinner’s device was superior to other World War II missile guidance systems, it was never implemented.

 

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Kenneth E. Behring Center, Division of Medicine & Science, National Museum of American History, Smithsonian Institution.

Token Economies

A widely used application of operant learning is the  token economy . Money, in the form of coins, bills, bitcoins, or bank statements, is fairly useless. You can’t eat it, wear it, or shelter in it. Nonetheless, people value it because it takes on secondary reinforcing qualities due to its history of association with other things that have intrinsic value. The use of money to buy things of personal value is an example of a token economy. You earn money for doing certain things, and then you have the opportunity to trade the money you earned for items of value to you. This system meets the best practices criteria that have been described in the context of positive reinforcement. Each person can obtain reinforcement that has unique personal value. One friend may spend discretionary money on going out to dinner, while another invests in the stock market. Both find money reinforcing for doing work.

Token economies can be effective ways of managing behavior. Tokens, including money, can be traded for a valued reinforcement of the worker’s choice. This woman’s purchase might motivate her work, but another worker might use the same paycheck to buy a motorcycle or go on vacation.

 

OJO Images/Photoshot

An informed approach to compensating employees should include consideration of learning principles. “Menu” approaches to employee benefits provide an excellent example of this application. Historically, employers offered a set program of health, retirement, and other benefits to their entire workforce regardless of individual needs. We would expect this approach to be minimally reinforcing because it does not match reinforcers to worker priorities. Catering a benefits package to individual needs is more sensible. A young worker in good health might be more motivated by a benefits package that includes childcare, while a more mature worker may worry about long-term care in the event of a disability. By allowing workers to select their benefits from a menu, everybody can find something worth earning.

All of us respond positively to token economies, but they are especially useful in educational and institutional settings. Teachers provide frequent rewards in the form of checks, stars, or tickets that can be exchanged later for popcorn parties or a night without homework. The key to an effective token economy is to offer ultimate rewards that are truly valuable to the people you wish to motivate. If students don’t care about popcorn parties, offering them will have little effect. Token economies are equally useful in prison settings and in institutions serving people with an intellectual disability or mental illness.

Behavior Therapies

As we will discuss in Chapter 15, learning theories also have been applied successfully to the clinical setting in the form of behavior therapies, also called applied behavior analysis. After all, our formal definition of learning states that it involves a change in behavior, and changing behavior is precisely what therapists usually seek to do. In addition to the extinction and counterconditioning applications of classical conditioning, behavior therapies use operant conditioning concepts such as extinction, reward, and on rare occasions, punishment.

An important application of operant conditioning principles is their use in behavior therapies for conditions like autism spectrum disorder. Operant conditioning can be used to increase the frequency of language use and socially appropriate behaviors, like eye contact.

 

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Coupled with cognitive methods designed to address the way that people think about their circumstances, these methods comprise the most popular and effective means for treating many types of disorder, from substance abuse to depression. One of the most dramatic applications of behavior therapy is the treatment for autism spectrum disorder pioneered by O. Ivar Lovaas (Lovaas, 1996; Lovaas et al., 1966). Autism spectrum disorder is characterized by language and social deficits. Although behavior therapy doesn’t cure autism spectrum disorder, behavioral interventions, like the use of chaining described previously, typically improve an individual’s level of functioning.

Experiencing Psychology

How Do I Break a Bad Habit?

We all have behaviors that could use some improvement. Maybe we eat poorly, drink too much, smoke, or lash out angrily at others. An understanding of the processes of learning provides us with powerful tools for changing behavior. Let’s assume that your eating habits, like those of many students, do not meet the “My mom would approve” standard. Yet you are learning in your psychology course that good health habits are essential tools for managing stress (see Chapter 16). How do you bring about the necessary changes?

Before doing anything to produce change, you need to understand your current behavior. Many people have a poor understanding of what they actually eat during a day, so you could start by keeping a diary. What foods, and how much of them, do you eat? What else is going on when you eat well or poorly? What possible reinforcers or punishers are influencing your eating patterns? For example, let’s say that you observe a tendency to eat high-calorie snacks late at night while studying, even when you are not hungry. Your goal, then, is to eliminate these late-night snacks. Your baseline shows that your snacking is a social behavior. You consume these extra foods only when studying with a group. The social camaraderie and good taste of the food serve as powerful reinforcers for the behavior.

Now that you have a better understanding of your problem behavior, you are in a good position to construct a plan. An important part of your plan is to choose appropriate consequences for your behavior. Again, it is essential that we design consequences that are meaningful to individuals. As we have argued in this chapter, positive reinforcement has many advantages over punishment. You might try placing the money you’re saving on junk food in a designated jar to buy a special (nonfood) treat at the end of a successful week, or allow yourself an extra study break each night that you meet your goals. If you are convinced that the only way that you will change is through punishment, you could take an alternative approach. Although some people have successfully stopped smoking through the use of positive punishment, including electric shock (Law & Tang, 1995), this sounds quite unpleasant. Instead, a negative punishment, such as losing texting privileges for the day following a failure to meet one’s goals, might work.

 

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As you implement your program, track your progress and make any modifications that seem necessary. In addition to the improvement of your target behavior, a beneficial side effect of applying learning methods to your behavior is the knowledge that given the right tools, you can control your behavior.

Biopsychosocial Assessment: Part 2

Refer back to the movie you selected and watched or the case study you read during Topic 1. Continue working on the biopsychosocial assessment submitted in Topic 2 and complete Part 2 of the biopsychosoical assessment. Make any suggested changes from your instructor.  While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.  You are required to submit this assignment to LopesWrite. Refer to the directions in the Student Success Center.  This assignment meets the following NASAC Standards:  25) Gather data systematically from the client and other available collateral sources, using screening instruments and other methods that are sensitive to age, culture and gender. At a minimum, data should include: current and historic substance use; health, mental health, and substance-related treatment history; mental status; and current social, environmental, and/or economic constraints on the client’s ability to follow-through successfully with an action plan.  28) Determine the client’s readiness for treatment/change and the needs of others involved in the current situation.  29) Review the treatment options relevant to the client’s needs, characteristics, and goals.  31) Construct with the client and others, as appropriate, an initial action plan based on needs, preferences, and available resources.  32) Based on an initial action plan, take specific steps to initiate an admission or referral, and ensure follow-through.  33) Select and use comprehensive assessment instruments that are sensitive to age, gender and culture, and which address: (a) History of alcohol and other drug use (b) Health, mental health, and substance-related treatment history (c) History of sexual abuse or other physical, emotional, and verbal abuse, and/or other significant trauma (d) Family issues (e) Work history and career issues (f) Psychological, emotional, and world-view concerns (g) Physical and mental health status (h) Acculturation, assimilation, and cultural identification(s) (i) Education and basic life skills (j) Socio-economic characteristics, lifestyle, and current legal status (k) Use of community resources (l) Behavioral indicators of problems in the domains listed above.  34) Analyze and interpret the data to determine treatment recommendations.  36) Document assessment findings and treatment recommendations.  37) Obtain and interpret all relevant assessment information.  111) Prepare accurate and concise screening, intake, and assessment reports.

PCN-610 Option 2: Case Study

David is a 49-year-old married man with two adult children. He has been married for 21 years. He has been employed as a metallurgical engineer in a local steel mill for 20 years. David noted he use to enjoyment going to work, but now, he states some days he would rather just stay home. David married his high school sweetheart. He describes their relationship as “typical.” They eat meals and attend family gatherings together but do little else as a couple. David use to spend his spare time reading, playing golf, and watching TV. For the last 6 months, David has felt blue and his appetite has decreased. He stated he doesn’t have any desire to do any of things he use to enjoy and would rather spend time alone in his bedroom. David complained of irritability and low energy. Within the last 2 months, David noted he has experienced more physical pain in his back and neck area. Because he has not been sleeping well, David drinks more at night. He stated that when he was younger, he use to drink more frequently but now he only drinks two or three beers per night. Sometimes, he feels like life is hardly worth living. David has tried to “snap himself” out of this sour mood, but nothing seems to work. David oldest son stated he is concerned his father may need to go see a doctor, because his father appears to be acting usual. David stated that his sister used to have similar problems. He is resistant to going to see a doctor and believes his mood will eventually improve.

David’s sister Lisa has struggled with depression for over 10 years. She is currently seeing a psychiatrist and a counselor. In the past, Lisa reported an increase in emotional and physical fatigue, low mood, increased weight gain, and disrupted sleep. Lisa has a negative outlook and states that when things are looking up, something always goes terribly wrong.

 

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STANDARDS ON ASSESSMENTS AND THERAPY

PART1-Due Thursday

Respond to the following in a minimum of 175 words:

Review this week’s course materials and learning activities, and reflect on your learning so far this week. Respond to one or more of the following prompts in one to two paragraphs:

  1. Provide citation and reference to the material(s) you discuss. Describe what you found interesting regarding this topic, and why.
  2. Describe how you will apply that learning in your daily life, including your work life.
  3. Describe what may be unclear to you, and what you would like to learn.

PART2- 

Case Study Seven Worksheet

Respond to the following questions in 1,250 to 1,500 words.

1. Why is this an ethical dilemma? Which APA Ethical Principles help frame the nature of the dilemma?

2. To what extent, if any, should Dr. Vaji consider Leo’s ethnicity in his deliberations? Would the dilemma be addressed differently if Leo self-identified as non-Hispanic White, Hispanic, on non-Hispanic Black?

3. How are APA Ethical Standards 1.08, 3.04, 3.05, 3.09, 7.04, 7.05, and 17.05 relevant to this case? Which other standards might apply?

4. What are Dr. Vaji’s ethical alternatives for resolving this dilemma? Which alternative best reflects the Ethics Code aspirational principle and enforceable standard, as well as legal standards and obligations to stakeholders?

5. What steps should Dr. Vaji take to ethically implement his decision and monitor its effects?

Reference

C. B. (2013). Decoding the ethics code: A practical guide for psychologists. Thousand Oaks, CA: Sage.

PART3-Develop an 2-slide Microsoft® PowerPoint® presentation with detailed speaker notes on the selection process of a culture-neutral assessment. Include examples of when culture-biased assessments have been problematic.

Use a minimum of 2 peer reviewed (scholarly journal articles) sources.

(I WILL ADD MORE DETAILS FOR PART 3 BY TUESDAY)

REFERENCE

Chapter 12 Standards on Assessment 9. Assessment

9.01 Bases for Assessments

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Psychological assessment serves the public good by providing information to guide decisions affecting the well-being of individuals, families, groups, organizations, and institutions. Psychologists who base their conclusions about information and techniques on the scientific and professional knowledge of the discipline are uniquely qualified to interpret the results of psychological assessments in ways that merit the public trust. However, the public and the profession are harmed when psychologists provide opinions unsubstantiated by information obtained or drawn from data gathered through improper assessment techniques (Principle A: Beneficence and Nonmaleficence; Principle B: Fidelity and Responsibility). Standard 9.01a of the APA Ethics Code (APA, 2010b) prohibits psychologists from providing written or oral opinions that cannot be sufficiently substantiated by the information obtained or the techniques employed.

The standard is broadly worded to apply to all written and oral professional opinions, irrespective of information recipient, setting, or type of assessment.

Information Recipient

The standard prohibits unfounded professional opinions offered to, among others, (a) individual clients/patients or their representatives; (b) other professionals; (c) third-party payors; (d) administrative and professional staff at schools, hospitals, and other institutions; (e) businesses, agencies, and other organizations; (f) the courts; (g) the military or other governing legal authorities; and (h) callers to talk radio programs or those interacting with psychologists via the Internet or through other media.

Need to Know: Assessment in Child Protection Matters

Forensic examiners retained in response to an accusation of child abuse and neglect need to obtain competencies relevant to the intersecting interests of the child, the parents, and the state, including laws on parental termination and the role of kinship and policies favoring child placement with extended family members in favor of foster care (Standard 2.01f, Competence; APA, 2013b). The primary purpose of the assessment is to help government agencies and courts determine whether a child’s health and welfare may have been and/or may be harmed. Consequently, in addition to the broader parent–child “fit” considerations typical of custody evaluations, psychologists need to select assessment techniques sufficient to address the particular vulnerabilities and risks of maltreatment associated with specific child characteristics (e.g., children with developmental disabilities or other medical needs) and the need for and likelihood of success of clinical interventions for problems associated with abuse, maltreatment, or neglect. This may include familiarity with techniques for assessing the role of specific cultural patterns of parenting, impact of familial separation, and foster and kinship-based alternative care. In interpreting results, psychologists must also refrain from assuming a child advocacy role and gather information impartially based on reliable methods established in the field (Standard 2.04, Bases for Scientific and Professional Judgments).

Setting

Standard 9.01a applies to (a) diagnostic opinions offered orally in the office of a private practitioner; (b) written reports provided to clients/patients, other practitioners, or third-party payors through the mail, the Internet, or other forms of electronic transmission; (c) testimony provided in the courts; and (d) opinions about an individual’s mental health offered over the Internet, radio, television, or other electronic media.

Types of Assessment

The standard pertains to all unfounded opinions claiming to be based on any form of evaluation, including but not limited to (a) standardized psychological, educational, or neuropsychological tests; (b) diagnostic information gained through clinical interviews; (c) collateral data obtained through discussions with family members, teachers, employee supervisors, or other informants; (d) observational techniques; or (e) brief discussion or correspondence with an individual via radio, television, telephone, or the Internet.

Violations of this standard are often related to failure to comply with other standards, including Standards 2.04, Bases for Scientific and Professional Judgments; 9.01b, Bases for Assessments; and 9.02b, Use of Assessments. For example, psychologists should not use test scores as sole indicators for diagnostic or special program placement but instead use multiple sources of information and, when appropriate, provide alternative explanations for test performance (AERA, APA, & NCME, 2014). The following are examples of opinions based on insufficient information or techniques that would be considered violations under this standard:

Psychologists who knowingly provide unsubstantiated opinions in forensic, school, or insurance reports fail to live up to the ideals of Principle C: Integrity and may also find themselves in violation of Standard 5.01, Avoidance of False or Deceptive Statements (see Hot Topic “Avoiding False and Deceptive Statements in Scientific and Clinical Expert Testimony,” Chapter 8). However, psychologists should also be alert to personal and professional biases that may affect their choice and interpretation of instruments. For example, in a survey of forensic experts testifying in cases of child sexual abuse allegations, Everson and Sandoval (2011) found that evaluator disagreements could be explained, in part, by individual differences in three forensic decision-making attitudes: (1) emphasis on sensitivity, (2) emphasis on specificity, and (3) skepticism toward child reports of abuse.

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Standard 9.01b specifically addresses the importance of in-person evaluations of individuals about whom psychologists will offer a professional opinion. Under this standard, with few exceptions, psychologists must conduct individual examinations sufficient to obtain personal verification of information on which to base their professional opinions and refrain from providing opinions about the psychological characteristics of an individual if they themselves have not conducted an examination of the individual adequate to support their statements or conclusions. As video conferencing and other electronically mediated sources of video communication become increasingly common, appropriately conducted assessments via these media may meet the requirements of this standard if the psychologist has had the appropriate preparatory training and the validity of the video methods of assessment has been scientifically and clinically established for use with members of the population tested (Standards 2.01e, Boundaries of Competence; 2.04, Bases for Scientific and Professional Judgment; 9.02, Use of Assessments).

Standard 9.01b also recognizes that in some cases, a personal examination may not be possible. For example, an individual involved in a child custody suit, a disability claim, or performance evaluation may refuse or, because of relocation or other reasons, be unavailable for a personal examination. The standard requires that psychologists make “reasonable efforts” to conduct a personal examination. Efforts that would not be considered reasonable in the prevailing professional judgment of psychologists engaged in similar activities would be considered a violation of this standard. Consider the following two examples of potential violations:

When, despite reasonable efforts, a personal interview is not feasible, under Standard 9.01b psychologists in their written or oral opinions must document and explain the results of their efforts, clarify the probable impact that the failure to personally examine an individual may have on the reliability and validity of their opinions, and appropriately limit their conclusions or recommendations to information they can personally verify. Psychologists may report relevant consistencies or inconsistencies of information found in documents they were asked to review (see Standard 9.01c below). However, they should avoid offering opinions regarding the personal credibility or truthfulness of individuals they have not examined or when basic facts contested have not been resolved through assessments (APA, 2013b).

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This standard applies to those assessment-related activities for which an individual examination is not warranted or necessary for the psychological opinion. Such activities include record or file reviews where psychologists are called on to review preexisting records and reports to assist or evaluate decisions made by schools, courts, health insurance companies, organizations, or other psychologists they supervise or with whom they consult. Record reviews can be performed to (a) determine whether a previously conducted assessment was appropriate or sufficient; (b) evaluate the appropriateness of treatment, placement, employment, or continuation of benefits based on the previously gathered information and reports; (c) adjudicate a disability or professional liability claim based on existing records; or (d) resolve conflicts over the applicability of records to interpretations of federal and state laws in administrative law or due process hearings (Bartol & Bartol, 2014; Hadjistavropoulos & Bieling, 2001).

Reviewers provide a monitoring function for the court or a function of forensic quality control so the court will not be misled by expert testimony of evaluators that is based on flawed data collection and/or analysis (Austin, Kirkpatrick, & Flens, 2011). According to Standard 9.01c, psychologists who provide such services must clarify to the appropriate parties the source of the information on which the opinion is based and why an individual interview conducted by the psychologist is not necessary for the opinion.

Simply complying with this standard may not be sufficient for psychologists who are in supervisory roles that carry legal responsibility for the conduct of assessments by unlicensed supervisees or employees. In many of those instances, psychologists may be directly responsible for ensuring that individuals are qualified to conduct the assessments and do so competently (see Standard 2.05, Delegation of Work to Others).

  • ☒ Testifying on the validity of a child abuse allegation based on the results of an idiosyncratic, improperly constructed parent checklist of child behaviors
  • ☒ Diagnosing an adult with impaired decisional capacity as developmentally disabled without taking a developmental history
  • ☒ Providing preemployment recommendations on the basis of a personality test with no proven relationship to job performance
  • ☒ Submitting a diagnosis of neurological impairment to a health insurance company based solely on information derived during therapy sessions
  • ☒ Informing parents that their preschooler is autistic on the basis of a single observational session
  • ☒ Recommending a child for special education placement solely on the basis of scores on a standardized intelligence test
  • ☒ Offering a diagnosis of PTSD based on a 5-minute discussion with a listener who calls in to a radio program hosted by the psychologist
  • ☒ Offering a diagnosis of bipolar disorder based on an individual’s comments on the psychologist’s blog
  • ☒ Submitting for health insurance reimbursement a diagnosis of dementia in an elderly patient complaining of memory lapses, without conducting a neuropsychological assessment

Digital Ethics: Use of Mobile Phones for Treatment Adherence Monitoring

For some mental health disorders such as anorexia nervosa, borderline personality disorder, and substance dependency, downloadable mobile phone applications (mHealth) for client/patient self-monitoring can be a valuable adjunct to in-person psychotherapy, as they can reduce vulnerabilities of memory and help clients/patients reflect critically on their thoughts and behaviors (Aardoom Dingemans, Spinhoven, & Van Furth, 2013; Ambwani, Cardi, & Treasure, 2014; Dimeff, Rizvi, Contreras, Skutch, & Carroll, 2011; Dombo et al., 2014). When deciding whether mHealth is clinically indicated for a specific client/patient, psychologists should consider (a) whether the client/patient can effectively use the technology without supervision, based on diagnostic assessment as well as conducting an in-office assessment of the client’s/patient’s ability to utilize the technology, and (b) the likelihood that clients/patients will become overdependent on the mobile technology in ways that jeopardize their ability to implement behavior management skills independent of the technology (Ambwani et al., 2014; Standards 2.04, Bases for Scientific and Professional Judgments, and 3.04, Avoiding Harm). To ensure appropriate confidentiality protections, psychologists should (a) assess risks to confidentiality that may be inherent in the client’s/patient’s home, work, and other treatment management–related environments; (b) utilize behavior management mobile applications and/or Internet sites with adequate security protections; and (c) provide clients/patients with instruction on how to protect their privacy and confidentiality (Standards 4.01, Maintaining Confidentiality; 4.02, Discussing the Limits of Confidentiality).

  • ☒ A psychologist testified about a parent’s psychological fitness for visitation rights, drawing his opinion solely from comments made by the child and divorced spouse in the absence of an individual examination of the parent.
  • ☒ A psychologist contracted by an insurance company to evaluate an individual’s mental health as part of a current disability claim provided an opinion based solely on job performance evaluations written by the insured’s immediate supervisors and diagnostic information collected by another psychologist prior to the incident cited in the claim.
  • ☒ A psychologist working in a correctional facility who was asked to recommend whether a prison guard’s mental status was a risk to prisoner protections did not personally examine the guard but instead gave an opinion based on reports by facility administrators, staff, and prisoners.
  • ☒ A psychologist was contracted by a prison to evaluate the job potential of guards hired for a probationary period. Without conducting an individual interview, the psychologist wrote a report concluding that emotional instability of one job candidate made him ineligible for full-time employment. The psychologist justified the lack of a personal examination on the fact that several coworkers had claimed the guard was too dangerous to interview.
  • ☒ A psychologist hired by the attorney of a husband engaged in a custody suit provided court testimony on the wife’s parenting inadequacies without having interviewed her personally. The psychologist claimed that the wife had not responded to the psychologist’s letter requesting the interview. On cross-examination, it was revealed that the letter written by the psychologist included the following language seemingly designed to discourage agreement to be examined: “I have reason to believe from interviews with your spouse and an examination of your children that you are responsible for the children’s current mental health problems and would like to conduct an examination to confirm or dispute these assumptions.”
  • ☑ A court-appointed psychologist attempted to contact the biological parent of a child currently in foster care to make recommendations regarding parental visitation. The parent was no longer at the last known residence and had not left a forwarding address. In testimony, the psychologist described the current mental health status of the child, the child’s statements regarding the biological parent, and the observed relationship between the child and foster parents. In referring to the biological parent, the psychologist informed the court of efforts to contact the parent, described how failure to interview the parent limited any conclusions that could be drawn regarding the parent’s psychological characteristics and parenting competence, and clarified that recommendations regarding visitation were based on the child’s attitudes, mental health, and foster care arrangements.

Review of Data From Surreptitious Investigative Recording

There are instances when forensic psychologists may be asked to evaluate past mental states from audio or video recordings of a defendant’s behavior at the time of the alleged offense or surreptitious recordings of a plaintiff’s behavior in a personal injury, insurance disability, or divorce case (Denney & Wynkoop, 2000). Before agreeing to review such recordings, psychologists should make sure that the surveillance information was obtained legally at the time it was recorded, that the party requesting the psychologist’s evaluation has the legal right to share such information, and that inadmissibility of such information will not compromise the psychologist’s findings. Psychologists should also take reasonable steps to ascertain that they have been provided with all legally available recordings and other available information relevant to the forensic opinion. The psychologist’s oral testimony or written report should clarify the source of the information and why an individual examination is not warranted or necessary for the type of evaluation requested.

9.02 Use of Assessments

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The appropriate use of psychological assessments can benefit individuals, families, organizations, and society by providing information on which educational placements, mental health treatments, health insurance coverage, employee selection, job placement, workers’ compensation, program development, legal decisions, and government policies can be based. The inappropriate use of assessments can lead to harmful diagnostic, educational, institutional, legal, and social policy decisions based on inaccurate and misleading information.

Standard 9.02a is concerned with the proper selection, interpretation, scoring, and administration of assessments. It refers to the full range of assessment techniques used by psychologists, including interviews and standardized tests administered in person, through the Internet, or through other media. According to this standard, ethical justification for the use of assessments is determined by research on or evidence supporting the purpose for which the test is administered, the method of administration, and interpretation of scores (AERA, APA, & NCME, 2014). To comply with the standard, psychologists should be familiar with and be able to evaluate the data and other information provided in test manuals detailing (a) the theoretical and empirical support for test use for specific purposes and populations, (b) the test’s psychometric validity, (c) administration procedures, and (d) how test scores are to be calculated and interpreted. Psychologists should also keep themselves apprised of ongoing research or evidence of a test’s usefulness or obsolescence over time (see also Standards 2.03, Maintaining Competence; 2.04, Bases for Scientific and Professional Judgments; 9.08b, Obsolete Tests and Outdated Test Results). The standard also requires that psychologists adhere to standardized test administration protocols to ensure that test scores reflect the construct(s) being assessed and avoid undue influence of idiosyncrasies in the testing process (AERA, APA, & NCME, 2014).

Violations of Standard 9.02a occur when psychologists use assessments in a manner or for a purpose that is not supported by evidence in the field (see also this chapter’s Hot Topic “The Use of Assessments in Expert Testimony: Implications of Case Law and the Federal Rules of Evidence”).

Modifications for Individuals With Disabilities

Test administration for individuals with disabilities may require modifications and adaptations in testing administration to minimize the effect of test taker characteristics incidental to the purpose of the assessment. Standard 9.02a permits departure from a standard administration protocol if the method of test adaptation can be justified by research or other evidence. For example, converting a written test to Braille for an individual who is legally blind, physically assisting a client with cerebral palsy to circle items on a written test, or providing breaks for an individual with a disability associated with frequent fatigue is acceptable if the particular disability is not associated with the construct to be measured by the test and there are professional or scientific reasons to assume that such modifications will not affect the validity of the test (AERA, APA, & NCME, 2014). However, such accommodations are not appropriate if the disability is directly related to the abilities or characteristics that the test is designed to measure. Any modifications to testing and potential limitations in interpretation must be documented. Federal regulations relevant to the assessment of individuals with disabilities include IDEA (http://idea.ed.gov), Section 504 of the Rehabilitation Act of 1973, revised 2006 (http://www.hhs.gov/civil-rights/for-individuals/disability/index.html), and ADA (http://www.ada.gov).

Digital Ethics: Internet-Mediated Assessments

Psychologists administering assessments via the Internet need to remain up-to-date on research demonstrating the assessments’ validity or lack thereof for use in this medium (Montalto, 2014; Standard 2.03, Maintaining Competence). Verification of the examinee’s age, gender, and honesty of disclosures is important to the assessment’s validity and reliability (Alleman, 2002). Some assessments developed for in-person administration require verbal, auditory, or kinesthetic clues for accurate diagnosis (Barak & English, 2002). When assessments have not been validated for use via the Internet, psychologists should make every effort to conduct an in-person evaluation. When this is not possible, psychologists should select instruments that research or other evidence indicates are most appropriate for this medium, implement when possible information-gathering techniques that can best approximate in-person settings (e.g., video and auditory interactive technology), and acknowledge limitations of the assessment in interpretations of the data (Standard 9.06, Interpreting Assessment Results). Technology-based testing is also related to concerns regarding standardized administration and construct validation. Psychologists need to be aware of limitations in administration and interpretation for examinees who may not have access to or are unfamiliar with the use of new technologies or will be using older computers or devices with slower processing speed (AERA, APA, & NCME, 2014; Standard 3.01, Unfair Discrimination).

  • ☒ A psychologist contracted to conduct employment testing for an organization administered a series of personality inventories with little or no validity evidence supporting the link between scores on the inventories and actual job performance.
  • ☒ A counseling psychologist working with an isolated rural community administered a series of tests over the Internet without previously establishing whether the Internet-mediated scores measured the same construct as scores from the paper-and-pencil version (Buchanan, 2002).
  • ☒ A school psychologist working under pressure to meet the school system’s quotas for weekly testing gave the same battery of tests to all students irrespective of their grade level or presenting problem.
  • ☒ A neuropsychologist conducted a forensic examination of a prisoner in a room occupied by other prisoners, thereby compromising the validity of score interpretation based on norms established under standardized distraction-free testing environments.

Need to Know: Assessment of Dementia

The APA Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change (APA, 2012d) stress the importance of using age-normed standardized psychological and neurological tests, being aware of the limitations of brief mental status examinations, and estimating premorbid abilities. The Guidelines also describe the following key elements that should be obtained to ensure accurate diagnosis of conditions associated with cognitive decline (p. 5):

  • The onset and course of changes in cognitive functioning
  • Preexisting disabilities
  • Educational and cultural background that could affect testing variability
  • General medical and psychiatric history
  • Past neurological history, including prior head injuries or other central nervous system insults (strokes, tumors, infections, etc.)
  • Current psychiatric symptoms and significant life stressors
  • Current prescription and over-the-counter medication use
  • Current and past use and abuse of alcohol and drugs
  • Family history of dementia

Presence of Third Parties to Assessments

Standard 9.02a requires that psychologists administer tests in a manner consistent with procedures and testing contexts used in the development and validation of the instruments. Many psychological assessment instruments and procedures are validated under administration conditions limited to the presence of the psychologist and testee. In rare instances, psychologists may judge it necessary to include third parties to control the behavior of difficult examinees (e.g., parents of young children, hospital staff for psychiatric patients with a recent history of violence). In such situations, psychologists should select assessment instruments that are least likely to lend themselves to distortion based on the presence of a third party and include in their interpretations of test results the implications of such violations of standardized testing conditions.

Psychologists providing expert forensic consultations in relation to a criminal case, tort litigation, insurance benefits, or workers’ compensation claims may find that the assessment validity of tests is compromised when third parties are present as mandated by state law, institutional policy, or a judge’s ruling. For example, in neuropsychological assessments related to workers’ compensation cases, the presence of the plaintiff’s legal counsel, family members, or company representatives may distort the testing process or render test scores and interpretations invalid if the third party influences the test taker’s motivation or behavior or the psychologist–testee rapport (American Academy of Clinical Neuropsychology, 2001). The use of data from such assessments may be unfair to individuals if it leads to invalid test administration or misleading interpretations of the testee’s responses (Principle D: Justice and Standards 1.01, Misuse of Psychologists’ Work; 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority; and 9.06, Interpreting Assessment Results). When there is no legal flexibility to deny third-party presence during an assessment, psychologists should select those tests and procedures found to be least susceptible to distortion under such conditions and ensure that their written reports highlight the unique circumstances of the assessment and the limitations in interpretation.

Trainees and Interpreters as Third Parties

Third parties may observe evaluations for training purposes or serve as interpreters when translation is necessary to ensure accuracy and fairness of assessments (Standard 9.02c, Use of Assessments). In such instances, psychologists must select procedures that research or other evidence has demonstrated can be applied appropriately under these circumstances, ensure that trainees and interpreters are trained adequately to minimize threats to the proper test administration, and include in their reports any limitations on conclusions due to the presence of the third parties (Standards 2.05, Delegation of Work to Others; 9.06, Interpreting Assessment Results).

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The central idea of fairness in psychological and educational testing is to identify and remove construct-irrelevant barriers to maximal performance and allow for comparable and valid interpretation of test scores for all examinees (AERA, APA, & NCME, 2014). The proper use of tests can further principles of fairness and justice by ensuring that all persons benefit from equal quality of assessment measures, procedures, and interpretation (Principle D: Justice; Standard 3.01, Unfair Discrimination). Fair applicability of test results rests on assumptions that the validity and reliability of a test are equivalent for different populations tested. Validity refers to the extent to which empirical evidence and psychological theory support the interpretation of test data, that is, whether the test measures the psychological construct it purports to measure. Reliability refers to the consistency of test scores when a test is repeated for an individual or for a given population (see AERA, APA, & NCME, 2014).

A test that is a valid and reliable measure of a psychological construct in one population may not adequately measure the same construct in members of a different population, especially if members of the population of interest were represented inadequately in the normative sample or if test validity has not been established specifically for that group. Standard 9.02b requires psychologists to select assessment instruments whose validity and reliability have been established for use with members of the population tested. This standard applies to psychological assessment of any population, including clients/patients, students, job candidates, legal defendants, and research participants.

To comply with this standard, psychologists, when selecting a test, must be familiar with the specific populations included in the standardization sample and the test’s validity and reliability estimates. At minimum, psychologists should determine the applicability of a test to an individual of a given age group, ethnicity/culture, language, and gender and, where applicable, disability or other population characteristic when scientific or professional evidence suggests that test scores may not be psychometrically, functionally, or theoretically comparable to scores for the reference groups on which the test was normed (Landwher & Llorente, 2012).

Psychologists should also be familiar with relevant federal laws on the selection and administration of nondiscriminatory assessment and evaluation procedures (e.g., IDEA, 34 CFR 300.30[c][1][i]).

The dynamic and evolving nature of this country’s cultural, political, and economic landscape creates situations in which population-valid and reliable tests of a psychological construct may not be available for the individual or group tested. Psychologists asked to evaluate individuals from such groups should select tests validated on other populations with caution because they may produce results that do not adequately assess the qualities or competencies intended to be measured (AERA, APA, & NCME, 2014). Recommendations based on these assessments in turn may lead to unfair denial of educational or employment opportunities, health coverage, legal rights, or necessary services (Principle D: Justice). According to Standard 9.02b, psychologists who use tests without established norms for the individual or population assessed must describe in their reports the strengths of using the specific test results as well as the limitations the use of such tests places on psychologists’ interpretations and recommendations.

Psychologists conducting evaluations with members of racial/ethnic minority or immigrant groups must be particularly sensitive to the lack of cultural consideration inherent in the most popularly used mental health diagnostic and classification tools: the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Classification of Diseases (ICD-11). To avoid errors that may be associated with applying these tools, Johnson (2013) recommended that psychologists (a) apply culturally competent skills to understand attitudes toward mental health that may affect the client’s general response to testing; (b) establish an initial trusting relationship with clients; (c) consider including a measure of acculturation; (d) become familiar with cultural conditions that can impact the sharing of personal history information and the presentation of symptoms; and (e), when appropriate, draw on the appendices in the DSM-5 and ICD-11 to proactively use culture as a factor in the diagnostic process.

  • ☒ A school psychologist was asked to evaluate a bilingual child whose family had recently moved to New York from Puerto Rico. The psychologist used the English version of a well-known intelligence test without considering whether the standardized Spanish version of the test was or was not more appropriate for the child.
  • ☒ A psychologist working in a nursing home always used the Beck Depression Inventory (Beck, Steer, & Brown, 1996) to assess patient depression without considering the appropriateness of other measures specifically standardized on elderly populations or populations with chronic illnesses.
  • ☒ A consulting psychologist was hired to evaluate the job performance of a factory supervisor who had a visual disability. The psychologist limited her assessment to oral administration of tests that were validated on individuals without vision impairment and neglected to assess unique ways in which the supervisor might successfully compensate for his disability.
  • ☑ A forensic psychologist was asked to evaluate the competence to stand trial of a prisoner who had recently immigrated to the United States from Botswana. The prisoner’s English was poor, but there were no tests for competence standardized for individuals from the prisoner’s cultural or language group. The psychologist selected the best culturally sensitive techniques and assessments available and in written conclusions to the court explained the limitations of the tests used.

Selection of “Culture-Free” Tests

School psychologists and neuropsychologists conducting assessments of intellectual, educational, and cognitive abilities may attempt to be culturally sensitive by “stacking” their test batteries with nonverbal visuoperceptual and motor tests when assessing patients who speak languages in which more traditional language-based tests are not available. The use of such tests requires ethical caution since nonverbal tests of cognitive ability can be just as culturally biased as verbal tests (Wong, Strickland, Fletcher-Janzen, Ardila, & Reynolds, 2000).

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Language differences are part of the cultural diversity, rich immigration history, and individual differences in hearing and other linguistically relevant disabilities that make up the demographic mosaic of the United States. The validity and applicability of assessment data can be severely compromised when testing is conducted in a language the testee is relatively unfamiliar with or uncomfortable using. Under Standard 9.02c, psychologists should select tests in the language that is most relevant and appropriate to the test purpose (AERA, APA, & NCME, 2014).

Whereas the inappropriateness of English-only-based psychological testing is obvious when testees speak little or no English, the hazards of English-only testing for bilingual persons or oral-language-only assessment of persons with hearing disabilities who can read lips and communicate in sign language are often overlooked. The linguistic competencies of individuals who are bilingual often vary with the mode of communication (e.g., oral vs. written language), language function (e.g., social, educational, or job related), and topical domain (e.g., science, mathematics, interpersonal relationships, self-evaluations). In addition, individuals’ language preferences do not always reflect their language competence. Individuals may be embarrassed to reveal that their English, hearing, or oral language is poor; believe non-English or nonhearing testing will negatively affect their evaluations; or misjudge their language proficiency. The following steps are recommended to help psychologists comply with Standard 9.02c (see also AERA, APA, & NCME, 2014):

  • Psychologists can use language tests that assess multiple language domains to determine language dominance and proficiency relevant to different modes of assessment (e.g., written, oral) and topics (e.g., academic, interpersonal).
  • Whenever possible, psychologists should use test translations that have been developed according to accepted methods of test construction (see Standard 9.05, Test Construction).
  • When a test is translated or adapted, test developers and test users must describe the adequacy of theory, evidence, and methods used to establish the validity of test score interpretations for intended use (see Standard 2.04, Bases for Scientific and Professional Judgments).
  • Additional testing or observation may be necessary to determine whether what appears to be eccentric behavior (e.g., short phrases or reticence in response to test questions) reflects differences in cultural communication styles or an individual characteristic.
  • To the extent feasible, psychologists must ensure the language competence of the test administrator (see also Standards 2.05, Delegation of Work to Others; 9.03c, Informed Consent in Assessments).
  • When interpreting assessment results, test norms for native speakers of English should not be used for individuals for whom English is a second language or should be understood in part as reflecting a level of English proficiency.
  • ☒ A neuropsychologist was hired by an insurance company to assess a recent Nigerian immigrant who claimed he had suffered brain damage from falling on the premises of a store insured by the company. Because the man had such limited English skills and no test was available in his primary language, the neuropsychologist decided that the most culturally sensitive approach would be to assess the man’s cognitive capacity with an assessment battery composed entirely of visuospatial, perceptual, and motor tasks. The psychologist’s report did not describe the limitations of test results based on the absence of language-based assessments of reasoning and other cognitive abilities, nor did the report acknowledge the absence of preinjury cognitive tests necessary to determine whether behavioral and cognitive functioning had declined after the fall (adapted from Wong, 2000).

When English or Other Language Proficiency Is Essential

There are instances when proficiency in English or another language is essential to the goal of the assessment. For example, the ability to communicate with English-speaking employees may be a necessary qualification for a successful applicant for a personnel position. Evaluating a student’s English proficiency may be necessary to determine appropriate educational placement. The ability to read and speak English may be important to certain service positions responsible for protecting public health, safety, and welfare. Inclusion of the phrase unless the use of an alternative language is relevant to the assessment issues indicates that Standard 9.02c permits psychologists to use tests in a language in which the testee may not be proficient, if effective job performance, school placement, or another goal of assessment requires the ability to communicate in that language.

9.03 Informed Consent in Assessments

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To comply with this standard, psychologists must obtain and document, with few exceptions, written or oral consent in the manner set forth in Standard 3.10, Informed Consent. Psychologists must provide individuals who will be assessed and, when appropriate, their legal representative a clear explanation of the nature and purpose of the assessment, fees, involvement of third parties, and limits of confidentiality. Psychologists should also be attuned to consent vulnerabilities related to transient disorders, such as depression (Ghormley, Basso, Candlis, & Combs, 2011) and develop appropriate measures to ensure consent comprehension.

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Core Elements of Informed Consent in Assessment

Nature of the Assessment

The nature of an assessment refers to (a) the general category of the assessment (e.g., personality, psychopathology, competency, parenting skills, neuropsychological abilities and deficits, employment skills, developmental disabilities), (b) procedures and testing format (e.g., oral interviews, written self-report checklists, behavioral observation, skills assessment), and (c) duration of the assessment (e.g., hours or multiple assessments).

Purpose of the Assessment

The purpose of the assessment refers to its potential use, for example, in employment decisions, school placement, custody decisions, disability benefits, treatment decisions, and plans for or evaluation of rehabilitation of criminal offenders.

Fees

Discussion of fees must include the cost of the assessment and payment schedule and should be consistent with requirements of Standard 6.04, Fees and Financial Arrangements. When applicable and to the extent feasible, psychologists must also discuss with relevant parties the extent to which their services will be covered by the individual’s health plan, school district, employer, or others (see Standard 6.04a and 6.04d, Fees and Financial Arrangements).

Third Parties

Involvement of third parties refers to other individuals (e.g., legal guardians), HMOs, employers, organizations, or legal or other governing authorities that have requested the assessment and to whom the results of the assessments will be provided. Psychologists should be familiar with ethical standards, state law, and federal regulations relevant to the appropriate role of third parties and the release and documentation of release of such information to others (see Standard 4.05, Disclosures). Psychologists asked to evaluate a child by one parent should clarify custody issues to determine whether another parent must give permission.

Confidentiality

Informed consent to assessments must provide a clear explanation of the extent and limits of confidentiality, including (a) when the psychologist must comply with reporting requirements such as mandated child abuse reporting or duty-to-warn laws and (b) in the case of assessments involving minors, guardian access to records (see discussion of parental access involving HIPAA, FERPA, and other regulations in Standards 3.10, Informed Consent; 4.01, Maintaining Confidentiality; and 4.02, Discussing the Limits of Confidentiality). Psychologists who administer assessments over the Internet must inform clients/patients, research participants, or others about the procedures that will be used to protect confidentiality and the threats to confidentiality unique to this form of electronic transmission of information (see also Standard 4.02c, Discussing the Limits of Confidentiality).

Implications of HIPAA for Confidentiality-Relevant Information

The HIPAA regulation most relevant to informed consent in assessments is the Notice of Privacy Practices. At the beginning of the professional relationship, covered entities must provide clients/patients a written document detailing routine uses and disclosures of PHI and the individual’s rights and the covered entities’ legal duties with respect to PHI. Psychologists conducting assessments should also be familiar with HIPAA-compliant authorization forms for use and release of PHI and HIPAA requirements for Accounting of Disclosures. These regulations are described in greater detail in the section “A Word About HIPAA” in the preface of this book and in discussions of Standard 3.10, Informed Consent, in Chapter 6; Standards 4.01, Maintaining Confidentiality, and 4.05, Disclosures, in Chapter 7; Standard 6.01, Documentation of Professional and Scientific Work and Maintenance of Records, in Chapter 9; and Standard 9.04, Release of Test Data, in this chapter.

Dispensing With Informed Consent

Under Standard 9.03a, informed consent may be waived when consent is implied because testing is conducted as (a) a routine educational activity, such as end-of-term reading or math achievement testing in elementary and high schools; (b) regular institutional activities, such as student and teaching evaluations in academic institutions or consumer satisfaction questionnaires in hospitals or social service agencies; or (c) organizational activity, such as when individuals voluntarily agree to preemployment testing when applying for a job.

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Standard 9.03a also permits psychologists to dispense with informed consent in assessment when testing is mandated by law or other governing legal authority or when one purpose of testing is to determine the capacity of the individual to give consent. For example, during an initial consultation, neuropsychologists may also need to determine whether a client/patient with suspected dementia or brain injury has the capacity to independently consent to a full cognitive and neuropsychological assessment. Forensic psychologists conducting civil capacity assessments of older adults must select appropriate assessment techniques for determining whether clients/patients meet the legal standards of diminished capacity, testamentary capacity, and other abilities relevant to decisional capacity as defined by law (Moye, Marson, & Edelstein, 2013). Ethical steps that must be taken in these contexts are discussed next under Standard 9.03b.

Under Standards 3.10b, Informed Consent, and 9.03a, Informed Consent in Assessments, informed consent in assessment is not required when an individual has been determined to be legally incapable of giving informed consent, when testing is mandated by law or other governing legal authority, or when one purpose of testing is to determine consent capacity. These waivers reflect the fact that the term consent refers to a person’s legal status to make autonomous decisions based on age, mental capacity, or the legal decision under consideration. Consistent with the moral value of respect for the dignity and worth of all persons articulated in Principle E: Respect for People’s Rights and Dignity, under Standard 9.03c, psychologists must provide all individuals, irrespective of their legal status, appropriate explanations of the nature and purpose of the proposed assessment. Readers may also refer to the Hot Topic in Chapter 6, “Goodness-of-Fit Ethics for Informed Consent Involving Adults With Impaired Decisional Capacity.”

Standard 9.03a often applies in situations where assessment is requested by parents of children younger than age 18 years or family members of adults with suspected cognitive impairments. In some contexts, the affirmative agreement of the testee is not required. In these situations, the psychologist must provide information in a language and at a language level that is reasonably understandable to the child or adult being assessed. When both the permission of the guardian and the assent of the child or cognitively impaired adult are sought, psychologists working with populations for whom English is not a first language should be alert to situations in which prospective clients/patients and their legal guardians may have different language preferences and proficiencies.

Need to Know: Informed Consent for Forensic Assessments Requested by an Examinee’s Attorney

When testing is requested by an examinee’s attorney, informed consent should help the examinee understand the difference between forensic and other psychological services. To accomplish this Younggren, Bennett, and Harris (https://www.trustinsurance.com/resources/download-documents/) recommended that forensic informed consent contracts include the following:

  • The evaluation is not being conducted for the purposes of counseling or treatment. The results may or may not be personally helpful to you but will provide your attorney with information on how you function psychologically.
  • Your participation in the assessment is voluntary, and you have the right to stop the evaluation at any time. However, there may be legal consequences to stopping that should be discussed with your attorney.
  • If you consent to the assessment, the report will be sent to the retaining party (e.g., the examinee’s attorney), who will have complete authority over the results.
  • When the evaluation is completed, with permission from your attorney, I may be able to meet with you to explain the results.
  • Although the forensic report is normally protected by attorney–client privilege, if used for legal proceedings, the report may be admissible into evidence, and the extent of other confidentiality protections will be determined by the rules of that legal system.

Mandated Assessments

The term informed consent is applied when individuals are legally permitted to make their own decisions about undergoing a psychological assessment and whether and to whom the results of testing are disclosed. The term does not apply when testing is mandated through a court order or other governing authority. Psychologists conducting forensic, military, or other assessments that have been legally mandated should provide the examinee with a notification of purpose that explains the nature and purpose of the testing, who has requested the testing, and who will receive copies of the report. If the examinee is unwilling to proceed following a thorough explanation, the forensic practitioner may attempt to conduct the examination, postpone the examination, advise the examinee to contact his or her attorney, or notify the retaining attorney of the examinee’s unwillingness to proceed (APA, 2013a).

Defendants who are entering a plea of insanity may not be able to act on their Fifth Amendment right to silence and avoidance of self-incrimination. To avoid compromising the admissibility of a comprehensive forensic evaluation, Bush et al. (2006) suggested that psychologists first assess competency, then sanity, and separate the reports given to the court to provide the court the opportunity to first determine the competence question.

Informed Consent for the Assessment of Malingering

Malingering refers to the intentional production of false symptoms to attain an identifiable external benefit (Butcher, Hass, Greene, & Nelson, 2015; Iverson, 2006; National Academy of Neuropsychology Policy and Planning Committee, 2000). Tests of symptom validity, exaggeration, and malingering have become integral components of neuropsychological evaluations for traumatic brain injury and other suspected neurological disorders. Some have argued that assessment of malingering is the number one priority of forensic assessment, preceding any professional conclusions in forensic evaluations (Brodsky & Galloway, 2003; Kocsis, 2011). Malingering can be manifested through intentional under- or overperformance during psychological assessment. Accurate assessment of malingering is ethically important because errors in diagnosis can impede justice when undetected in forensic procedures or obscure adequate treatment for psychopathology (Principle A: Beneficence and Nonmaleficence; Kocsis, 2011).

Some have questioned whether describing the purposes of tests for malingering during informed consent compromises the validity of the assessment or whether failing to include such information during informed consent violates testees’ autonomy rights (Principle E: Respect for People’s Rights and Dignity; Standard 9.03, Informed Consent in Assessments). Current standards of practice support communicating to testees prior to and during informed consent or notification of purpose that measures will be used to assess the examinee’s honesty and efforts to do well, without describing the particularities of the tests that will be used to measure exaggeration or other elements of malingering (Carone, Bush, & Iverson, 2013). Individuals undergoing evaluation for Social Security Disability benefits or compensation for work-, sport-, or military-related injuries may be wary of practitioners and feel the need to prove that they are neurologically compromised. In such contexts, psychologists should take extra steps to develop rapport and a trusting relationship and to craft language and procedures that ensure testees understand that honesty and effort are required; in some cases, this may involve reading the informed consent material to clients/patients (Carone et al., 2013; Chafetz, 2010). Carone et al. (2013) also provided guidance for how to include the results of effort, exaggeration, and other tests during feedback sessions with clients/patients (Standard 9.10, Explaining Assessment Results).

Research on Coached Malingering

A practical concern in the forensic assessment of defendants or plaintiffs is whether existing tests of malingering can detect over- or underexaggeration of symptoms when the examinee has been coached by individuals familiar with the tests (Butcher et al., 2015; Jelicic, Cuenen, Peters, & Merckelbach, 2011). When researchers attempt to study the extent to which commonly used tests are vulnerable to coached faking, there is a risk that the information provided to research participants or disseminated through publication will be used to improve the success of coached malingerers (Berry, Lamb, Wetter, Baier, & Widiger, 1994). Ben-Porath (1994) suggested that to protect against these risks, investigators can (a) coach research participants on items similar but not identical to those on the test under investigation, (b) provide only a brief synopsis of coaching instructions in published articles, and (c) release information on verbatim instructions only to those bound by the APA Ethics Code to protect the integrity of tests (see also Standard 9.11, Maintaining Test Security).

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Compliance with the consent requirements outlined in Standard 3.10 obligates psychologists to provide information in a language and at a language level that is reasonably understandable to the client/patient and, where applicable, his or her legally authorized representative. Psychologists may use the services of an interpreter when they do not possess the skills to obtain consent in the language in which the client/patient is proficient.

When delegating informed consent responsibilities to an interpreter, psychologists must ensure not only that the interpreter is competent in the consent-relevant language (see Standard 2.05, Delegation of Work to Others) but that the interpreter also understands and complies with procedures necessary to protect the confidentiality of test results and test security. An interpreter who revealed the identity of a client/patient or the nature of specific test items used during the assessment would place the psychologist who hired the interpreter in potential violation of this standard. Because test validity and reliability may be vulnerable to errors in interpretation, Standard 9.03c also requires that the involvement of the interpreter and any related limitations on the data obtained be clearly indicated and discussed in any assessment-based report, recommendation, diagnostic or evaluative statement, or forensic testimony.

9.04 Release of Test Data

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Definition of Test Data

In Standard 9.04a, the term test data refers to the client’s/patient’s actual responses to test items, the raw or scaled scores such responses receive, and a psychologist’s written notes or recordings of the client’s/patient’s specific responses or behaviors during the testing. The term notes in this standard is limited to the assessment context and does not include psychotherapy (or process) notes documenting or analyzing the contents of conversation during a private counseling session.

Test Data and Test Materials

Recognizing that availability of test questions and scoring criteria may compromise the validity of a test for future use with a client/patient or other individuals exposed to the information, Standard 9.04a distinguishes test data, which under most circumstances must be provided upon a client/patient release, from test materials, which under most circumstances should not (see Standard 9.11, Maintaining Test Security). The definition of test data does not include test manuals, protocols for administering or scoring responses, or test items unless these materials include the client’s/patient’s responses or scores or the psychologist’s contemporaneous notes on the client’s/patient’s testing responses or behaviors. If testing protocols allow, it is good practice for psychologists to record client/patient responses on a form separated from the test items themselves to ensure that upon client/patient request, only the test data and not the test material itself need be released.

The Affirmative Duty to Provide Test Data to Clients/Patients and Others Identified in a Client’s/Patient’s Release

Release to Clients/Patients

Under Standard 9.04a, psychologists have an affirmative duty to provide test data as defined above to the client/patient or other persons identified in a client/patient release. The obligation set forth by Standard 9.04a to respect clients’/patients’ right to their test data is consistent with legal trends toward greater patient autonomy and the self-determination rights of clients/patients as set forth in Principle E: Respect for People’s Rights and Dignity. Although not explicitly stated in the standard, it is always good practice for psychologists to have a signed release or authorization from the client/patient even if the data are to be given directly to the client/patient. This standard does not preclude psychologists from discussing with a client/patient the potential for misuse of the information by individuals unqualified to interpret it.

Digital Ethics: Client/Patient Requests for Electronic Records

The 2013 HIPAA Omnibus Rule permits patients to receive a copy of their health record in an electronic form. Covered entities are permitted to charge for the costs of supplies if the client/patient requires data to be provided on a USB flash drive, compact disc, or other electronic media and for the costs of having to hire technically trained staff to recover PHI (see Standard 6.04, Fees and Financial Arrangements).

Release to Others

A fundamental tension exists between the desire of psychologists to respect clients’/patients’ right to determine who will have access to their assessment results and the desire to ensure that the data are not reviewed by unqualified individuals who might misinterpret or misuse the data or violate contractual agreements designed to protect a test publisher’s proprietary interests (Principle A: Beneficence and Nonmaleficence; Principle D: Justice; Principle E: Respect for People’s Rights and Dignity). The language of Standard 9.04 reflects this tension by providing exceptions to the release of test data under conditions in which the release might lead to substantial harm or misuse of the test.

There are several reasons why the standard supports release of test data to clients/patients and those whom they authorize to receive the data. First, whether a person designated by the client/patient is qualified to use test data is determined by the context of the proposed use. For example, restricting release of test data to individuals with advanced degrees or licensure in professional psychology would preclude other qualified health care professionals from using the information. Broadening but limiting the definition of qualified person to health professionals might jeopardize appropriate judicial scrutiny of psychological tests and a client’s/patient’s right to the discovery process to challenge their use in court. Second, even if a consensus around the definition of a “qualified” person could be achieved, requiring a psychologist to confirm the education, training, degrees, or certifications of other professionals would pose a burden that might not be feasible to meet. Third, as described below, with few exceptions, HIPAA regulations require that covered entities provide clients/patients and their personal representatives access to PHI.

Withholding Test Data

Standard 9.04a permits psychologists to withhold test data to protect the client/patient or another individual from substantial harm. The standard also permits withholding test data to protect misuse or misrepresentation of the data or the test. Before refusing to release test data under this clause, psychologists should carefully consider the proviso in the standard that such decisions may be regulated by law. For example, when refusing a client’s/patient’s request to release test data based on the psychologist’s judgment that the data will be misused, psychologists should document in each specific case their rationale for assuming that the data will be misused and refrain from behaviors that may be in violation of other standards (e.g., Standard 6.03, Withholding Records for Nonpayment).

Need to Know: Access to Forensic Records

According to the Specialty Guidelines for Forensic Psychology (APA, 2013e), forensic psychologists should provide attorneys and others who retain their services access to and explanation of all information in their records relevant to the legal matter at hand, consistent with relevant law and applicable professional standards, institutional rules, and regulations. Forensic examinees are not provided access to their assessment data or records unless the retaining party provides written consent for their release (see Standard 9.03b, Informed Consent in Assessment).

Implications of HIPAA

Requiring psychologists to release test data to the client/patient or others pursuant to a client/patient release reflects a sea change in the legal landscape from paternalistic to autonomy-based rules governing access to health records. In particular, HIPAA establishes the right of access of individuals to inspect and receive copies of medical and billing records maintained and used by the provider for decisions about the client/patient. This requirement does not include psychotherapy notes or information compiled in reasonable anticipation of or use in civil, criminal, or administrative actions or proceedings. In addition, psychologists who are covered entities under HIPAA must provide such access to a client’s/patient’s personal representative.

HIPAA limits the ability of covered entities to use professional judgment to determine the appropriateness of releasing test data to clients/patients and their personal representatives. For example, the right of clients/patients to obtain their own test data under HIPAA regulations means in practice that they can pass it on to other individuals of their choice.

Harm

Under HIPAA, psychologists who are covered entities can deny client/patient access to test data if granting access is reasonably likely to endanger the life or physical safety of the individual or another person or, in some cases, likely to cause equally substantial harm (Principle A: Beneficence and Nonmaleficence). In addition, psychologists must allow clients/patients the right to have the denial reviewed by a designated licensed health care professional. HIPAA regulations thus limit psychologists’ ability to independently exercise their professional judgment as to what constitutes substantial harm to clients/patients.

Misuse or Misrepresentation of the Test

Release of “test data” that include client/patient responses recorded on the test protocol itself can raise issues of copyright protection and fair use by test development companies (Principle B: Fidelity and Responsibility). If testing protocols allow, psychologists may wish to record client/patient responses on a form separated from the test items themselves to comply with contractual agreements with test developers and to maintain test security (Standard 9.11, Maintaining Test Security). When test data cannot be separated from test materials that are protected by copyright law, psychologists’ decision to withhold release of test data would be consistent with HIPAA regulations and Standard 9.04a.

  • ☒ To protect against the misuse of test data in possible instances when they would be released to clients/patients or another identified person, a psychologist used an idiosyncratic code to record testees’ responses. When a client/patient requested the test data be released to another licensed practitioner, it was clear that the test data were undecipherable to others, and the psychologist refused to provide the code. The psychologist was in violation of Standard 9.04a and HIPAA regulations, because in this particular case there was no reason to assume misuse of test data. The psychologist’s failure to appropriately create and store records also violated Standard 6.01, Documentation of Professional and Scientific Work and Maintenance of Records.

Withholding Data in Anticipation of Their Use for Legal Purposes

There are instances, however, when HIPAA constraints are not at issue. For example, HIPAA does not require release of PHI to clients in situations in which information is compiled in reasonable anticipation of, or for use in, civil, criminal, or administrative actions or proceedings. In other instances, such as certain educational evaluations, test data may not come under the PHI classification, and thus the HIPAA Privacy Rule would not apply (see Standard 4.01, Maintaining Confidentiality).

Organizations, Courts, and Government Agencies

The use of the term client/patient in this standard refers to the individual testee and not to an organizational client. This standard does not require industrial–organizational or consulting psychologists to release test data to either an organizational client or an employee when testing is conducted to evaluate job candidacy or employee or organization effectiveness and does not assess factors directly related to medical or mental health conditions or services. Psychologists working in these contexts would not be required to provide the test data to the employees themselves under this standard because the organization, not the employee, is the client (see also Standards 3.07, Third-Party Requests for Services; 3.11, Psychological Services Delivered To or Through Organizations; 9.03, Informed Consent in Assessments). Similarly, forensic psychologists, military psychologists, and others working under governing legal authority are permitted by the Ethics Code to withhold release of test data from a testee when the client is an attorney, the court, or other governing legal authority. Finally, all psychologists are permitted by the Ethics Code to withhold release of test data when required by law (Standard 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority).

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Standard 9.04b recognizes the clients’/patients’ right to expect that in the absence of their release or authorization, psychologists will protect the confidentiality of test data. The standard does permit psychologists to disclose test data without the consent of the client/patient in response to a court order (including subpoenas that are court ordered) or in other situations required by law (e.g., an order from an administrative tribunal). In such instances, psychologists are wise to seek legal counsel to determine their legal responsibility to respond to the request (see also Standard 4.05b, Disclosures). Psychologists may also ask the court or other legal authority for a protective order to prevent the inappropriate disclosure of confidential information or suggest that the information be submitted to another psychologist for qualified review (see also Standard 1.02, Conflicts Between Ethics and Law, Regulations, and Other Governing Legal Authority).

Implications of HIPAA

Standard 9.04b provides stricter protection of confidential test data than does HIPAA. Under the HIPAA Privacy Rule, PHI may be disclosed in response to a subpoena, discovery request, or other lawful process that is not accompanied by an order of a court or administrative tribunal, if the covered entity receives satisfactory assurance from the party seeking the information either that reasonable efforts have been made to ensure that the client/patient has been notified of the request or reasonable efforts have been made to secure a qualified protective order. Psychologists who disclosed information in such an instance would be in violation of 9.04b. The greater protection provided by 9.04b is consistent with most states’ more stringent psychotherapist–patient privilege communication statutes.