Intelligence Testing And Cut-Off Scores

Assessment methods provide data to the clinician, however, the clinician must decide how to use the data in making a decision or recommendation with regard to the client. The assessment data do not make the decision for the clinician, rather the data are used by the clinician in making the decision. The process of clinical decision-making requires the clinician to apply the data to clinical “decision rules or guidelines.” For example, one guideline may be that if a clinician believes that their client, as a result of a mental illness, poses a substantial and imminent risk of harm to self or others then that clinician is obligated to pursue available means to have the client hospitalized. If a client reports suicidal ideation then the clinician must apply this information to their “decision rule” to determine if hospitalization is warranted. Also, the criteria determining an intellectual disability indicates a significantly below-average performance on a standardized test of intelligence, the presence of functional impairments, and onset prior to age 18. The criterion for establishing significant impairment in intelligence is frequently established as a score below 70 on a standardized test of intelligence.

All psychological tests have some degree of error and this reduces the accuracy of a score. Therefore, it cannot be established with certainty that an individual has a specific IQ of 69, 70, or 71, rather, there is a certainty of a score within a particular range, accounting for error. This application of data to clinical decisions is referred to as “clinical validity”—is the decision clinically valid? Clinicians must carefully assess their confidence in their decision as well as the consequences of an error in clinical judgment as a result of ever-present measurement error.

This week you are asked to take a position with regard to a current legal standard. Review this week’s Learning Resources and analyze the Virginia v. Atkins ruling in which the Supreme Court has determined that it is unconstitutional to execute an individual who has an intellectual disability. In its decision the court stipulated that one criterion is an IQ score below 70. Consider the use of this “cut-off” score in formulating this type of decision. Remember, this is not a discussion about the death penalty; rather, it is a discussion about the use of specific cut-off scores in making clinical, administrative, or legal decisions.

With these thoughts in mind:

 

Post by Day 4 an argument for or against the use of cut-off scores in diagnoses that might affect court decisions. Use the current literature to support your response. Then, justify an alternative solution to this issue using the Learning Resources and current literature to support your response. Finally, explain one way cut-off scores might be applied in clinical practice.

 

No more than 500 words

 

APA format

 

answer all the questions

 

no title page

 

Atkins v. Virginia: Implications and recommendations for forensic practice

BY GILBERT S. MACVAUGH III, PSY.D. AND MARK D. CUNNINGHAM, PH.D., ABPP

In 2002, the United States Supreme Court held in the landmark case of Atkins v. Virginia that the execution of individuals who have mental retardation is unconstitutional. Following the Atkins holding, courts in death penalty jurisdictions have relied heavily upon mental health professionals in making a determination of whether or not capital offenders have mental retardation. The determination of mental retardation in death penalty cases, however, presents complex challenges for both courts and mental health professionals. In addition, there is variability in how death penalty states define mental retardation and in the assessment methods used by mental health professionals to diagnose mental retardation in such cases. The purpose of this article is to (a) describe how statutes in death penalty jurisdictions have operationalized the various clinical definitions of mental retardation, (b) discuss issues confronting examiners in assessing and diagnosing mental retardation in Atkins cases, and (c) provide recommendations for forensic practice.

KEY WORDS: Mental retardation, Atkins, death penalty, capital punishment, intelligence, adaptive functioning, malingering.

© 2010 by Federal Legal Publications, Inc.

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In 2002, the United States Supreme Court held in Atkins v. Virginia that the execution of individuals who have mental retardation is unconstitutional because it violates the Eighth Amendment’s prohibition against cruel and unusual punishments. Bonnie (2004) has observed that one of the “striking aspects” of the Court’s decision in Atkins is that this prohibition is framed in the language of a clinical diagnosis. No other class of individuals is constitutionally exempt from the death penalty solely on the basis of a psychological diagnosis (DeMatteo, Marczyk, & Pich, 2007). Equally striking, the Atkins decision elevated psychodiagnostic assessment to an unprecedented position in criminal law. For the first time, a score on a psychological test(s) and an associated diagnostic finding became dispositive. Mental health professionals, by necessity, have become primary sources of information and expertise regarding these assessment and diagnostic determinations.

The scholarly literature has lagged in grappling with the complex issues surrounding professional practice in performing these assessments. Similarly, the fields of psychology and psychiatry are only just beginning to develop formal standards or guidelines for professional practice in Atkins cases. This is surprising, as there is no other type of psychodiagnostic evaluation in which the stakes are higher and the consequences of misdiagnosis are greater. The necessity of developing standards for evaluations in Atkins cases is also demonstrated by the limited specialized training of professionals undertaking these evaluations. As Olley (2006b) points out, few psychologists have extensive specialized training in the areas of forensic evaluation and mental retardation. In an unpublished survey by Macvaugh and Grisso (2006) of 20 forensic clinicians’ practices in post-conviction Atkins cases, 40% reported formal training in mental retardation, and 45% reported at least some formal training in forensic evaluation. Only one of the forensic clinicians surveyed (5%) reported significant formal training and experience in both the fields of mental retardation and forensic

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evaluation. This is particularly problematic in light of the observation of Keyes, Edwards, and Derning (1998): “Training in traditional mental health graduate programs includes little, if any, information about mental retardation” (p. 535).

Professional standards for Atkins evaluations would promote greater uniformity of these evaluations, a characteristic that is not currently present. Results of informal surveys of psychologists’ professional practices in Atkins cases suggest that there is much variability in the assessment methods used to assess and diagnose mental retardation (Everington & Olley, 2004; Macvaugh & Grisso, 2006). Further, the articulation of such standards would illuminate what is generally accepted in the field, one of the factors governing the admissibility of scientific evidence (Daubert v. Merrell Dow Pharmaceuticals, Inc., 1993).

In 2005, Division 33 of the American Psychological Association (Mental Retardation and Developmental Disabilities) formed an Ad Hoc Committee (Olley, Greenspan, & Switzky, 2006) to identify issues related to mental retardation and the death penalty and to clarify psychologists’ role in Atkins proceedings. In August of 2008, the Ad Hoc Committee held a meeting at the American Psychological Association’s annual convention in Boston, Massachusetts to address the issue of standards of practice in Atkins cases. At this meeting, a panel of experts in the fields of mental retardation, forensic psychology, law, psychometrics, and others, convened to begin working on determining areas of consensus in the field regarding the assessment of mental retardation in Atkins proceedings. The panel interpreted the results of several recent unpublished surveys regarding professional practice in Atkins cases and began developing position statements regarding best practice. The results of the surveys reviewed by the panel are expected to be published in the near future. The work of the Ad Hoc Committee and position statements regarding the issues described above also are pending.

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This article seeks to inform the discussion on professional standards of practice for evaluations of mental retardation in capital cases by considering how this landmark decision has been variously operationalized by statutes across death penalty jurisdictions, the commonalities and differences in “clinical” definitions of mental retardation, and issues encountered by mental health professionals who conduct evaluations of mental retardation in capital cases. The associated “practice recommendations” are those of the authors alone.

Operationalizing Atkins

The Atkins Court made reference to definitions of mental retardation both by the American Association on Mental Retardation (AAMR, 1992) and the diagnostic criteria for mental retardation in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV- TR) (American Psychiatric Association, 2000). These will be detailed subsequently. The Court, however, left to the individual states the task of how to define mental retardation, as well as the procedures for making these determinations. This lack of specificity would seem to be a prudent way of allowing for the inevitable evolution of the diagnostic criteria of mental retardation as this intellectual and behavioral deficiency is understood by the mental health professions, as well as providing individual states some discretion in selecting from the various professionally-accepted diagnostic criteria. An unsurprising expression of this ambiguity is the variability across death penalty jurisdictions regarding which definition of mental retardation is used (DeMatteo et al., 2007) and the procedures for assessments and determination of mental retardation in such cases (Duvall & Morris, 2006).

A wrinkle of some moment, however, is introduced by the rather cryptic language of the majority opinion:

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In this case, for instance, the Commonwealth of Virginia disputes that Atkins suffers from mental retardation. Not all people who claim to be mentally retarded will be so impaired as to fall within the range of mentally retarded offenders about whom there is a national consensus. (Atkins v. Virginia, 2002, p. 317)

This language can be interpreted as standing for the proposition that some offenders will attempt to assert mental retardation who do not meet the nationally-accepted diagnostic criteria to be classified as “mentally retarded.” Alternatively, this language could reflect an expectation that not all persons with mental retardation will be “retarded enough” to qualify for an exemption from the death penalty. In this latter interpretation, the diagnosis of mental retardation is a necessary, but not sufficient condition. Instead of a national consensus regarding diagnostic classification (i.e., substantially a professional/clinical determination), this latter interpretation invokes a “community values” determination not unlike competency and sanity considerations. A “community values” approach to restricting death penalty exemption to a subcategory of capital offenders with mental retardation has been asserted by the Texas Criminal Court of Appeals in Ex parte Briseno (2004).

It is thus understandable that those in the mental health profession should define mental retardation broadly to provide an adequate safety net for those who are at the margin and might well become mentally-unimpaired citizens if given additional social services support. We, however, must define that level and degree of mental retardation at which a consensus of Texas citizens would agree that a person should be exempted from the death penalty. Most Texas citizens might agree that Steinbeck’s Lennie [Footnote: See John Steinbeck, Of Mice and Men (1937)] should, by virtue of his lack of reasoning ability and adaptive skills, be exempt. But, does a con- sensus of Texas citizens agree that all persons who might legiti- mately qualify for assistance under the social services definition of mental retardation be exempt from an otherwise constitutional penalty? Put another way, is there a national or Texas consensus that all of those persons whom the mental health profession might diagnose as meeting the criteria for mental retardation are automati- cally less morally culpable than those who just barely miss meeting those criteria? Is there, and should there be, a “mental retardation”

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bright-line exemption from our state’s maximum statutory punish- ment? As a court dealing with individual cases and litigants, we decline to answer that normative question without significantly greater assistance from the citizenry acting through its Legisla- ture…Some might question whether the same definition of mental retardation that is used for providing psychological assistance, social services, and financial aid is appropriate for use in criminal trials to decide whether execution of a particular person would be constitutionally excessive punishment. (Ex parte Briseno, 2-11-04)

Two aspects of this Texas Court of Criminal Appeals decision are notable. First, a Texas consensus is substituted for a national consensus as specified by the Atkins Court. Second, the seven criteria specified by the Texas Court of Criminal Appeals to identify the subcategory of capital offenders with mental retardation who would be exempted from the death penalty reflect a level of impairment that is consistent with Moderate Mental Retardation (IQ = 40-55) or Severe Mental Retardation (IQ = 25-40), rather than the Mild Mental Retardation category (IQ = 55-70), which constitutes virtually all capital offenders who have mental retardation. The seven criteria of the Briseno opinion operationalize an Atkins interpretation that only exempts a subcategory of persons with mental retardation from execution. That said, the authors are unaware of a case—in Texas or elsewhere— where a capital defendant was identified as having mental retardation by clinical/professional standards, but then found not retarded enough to be exempted from the death penalty.