45
Psychological Testing in Child and
a sociopath, because the MMPI-2 Scale 4 (Psycho-pathic Deviate) is elevated; he does not indicate the extent of the elevation. He also expresses concern that the father has seen human figures on Card III of the Rorschach as having both breasts and penises; he offers that this response is indicative of confusion of sexual identity and fits a sexual abuser profile. He also notes that one of the children has drawn a figure with-out hands, which the psychologist maintains indicates possible conflict over aggression or sexuality, which in turn suggests that this child has been a victim of sexual abuse. The examiner recommends that sole custody be awarded to the mother and that parenting time with the father be suspended until he has entered psy-chotherapy because of his clear potential for sexual abuse.
Case Example 3
An 11-year-old boy and his 9-year-old sister are present when the boy’s clothing is ignited by contact with an electric heater; the boy is severely burned on his face and hands. The parents sue the maker of the heater and the store that sold it. Among the damage claims is the psychological trauma to the boy as a result of the burns and to his sister from witnessing the event. A psychiatrist/psychologist team is asked to evaluate the children. Interviews are conducted with the children and their parents. The boy will say little about the injury and seems withdrawn; the parents are concerned about the withdrawal but say he has always been a child who does not talk about his problems. He was tested in school prior to the injury because of these concerns. The daughter freely discusses the experience without much difficulty and says that she feels sorry for her brother, but she is not very worried about it. The parents indicate they have been able to talk at length with the daughter about the situation.
A battery of tests is given to each child. The daughter responds within normal limits on all of the tests. She shows healthy problem-solving abilities and good overall adjustment. The son’s test results, on the other hand, show pervasive concerns about body integrity. Images of fire are everywhere, and projec-tive stories primarily consist of children being injured or in grave danger. There are test indications of marked social withdrawal and anxiety.
LEGAL ISSUES
Psychologists in the United States have testified on a variety of legal issues since the 1920s, either on the basis of research findings or on the results of psychological testing. Controversies concerning the admissibility of clinical psychological testimony based on testing have in almost all jurisdictions been resolved in favor of broad latitude to psychological expert testimony.
The chief issue before the courts in years past was whether medical training or methodology was necessary for expert testimony regarding mental and emotional conditions; the general response has been that it is not.
Where psychologist qualifications have been mentioned in appellate decisions discussing the admissibility of testi-mony based on testing, they have included factors such as the possession of a doctorate, licensing, teaching experi-ence, publication in professional journals, membership in the American Psychological Association, and certification by the American Board of Professional Psychology. Med-ical credentials as such have not been specified as neces-sary, nor has medical supervision of psychological work.
A secondary controversy regarding the admissibility of testimony based on psychological testing pertains to the scientific acceptability of test findings in general and of particular test instruments. As indicated below, all tests are not created equal in regard to reliability and validity, and some tests are more applicable to legal issues than are others. On this question, courts have generally upheld the admissibility of psychological testing, leaving open the question of the weight that might be accorded to it. Testing in general and certain instruments in partic-ular—those deficient in psychometric foundation—
remain subject to challenge in court, in the voir dire of the proposed psychological expert or in cross-examina-tion. This is no different, however, from the legal chal-lenges any mental health testimony is liable to face.
A related issue, and one which also concerns all expert testimony, is the extent to which psychological testimony should embrace opinions on the so-called ulti-mate issue—the factual and legal question on which the trier of fact must rule, such as the best interest of the child or the presence of negligence and damages. Rules of evidence adopted by the federal and state courts differ in regard to the limits placed on the scope of expert opinion testimony. Where opinions on ultimate issues are permit-ted, the adequacy of claimed bases for those opinions, whether psychological test data or other evaluative infor-mation, is subject to legal challenge.
CLINICAL ISSUES
Indications for Psychological Testing Contribution to the Overall Evaluation
Forensic questions about children can place clinicians in a position of tremendous responsibility. Because of the difficulty and importance of helping the court to decide such things as how a child’s life will be structured, whether to permanently terminate a parental
relation-ship, or how damaged a child might be from abuse, the evaluation must be extensive and thorough. Although psychological testing should never be used alone in mak-ing recommendations, it is often useful and sometimes essential to a comprehensive evaluation.
Psychological testing permits observation of each subject under controlled conditions. Ideally, tests are given to each subject in a uniform fashion: the same ques-tions are asked; and each subject is under the same expectations to respond. A relatively objective view of the subject is possible, in that the tests are constructed so as to minimize any influence or bias the examiner might bring to the evaluation.
Additionally, testing adds normative information to the picture. Psychological tests compare the performance of an individual to the performance of the general popu-lation or to a more specific popupopu-lation, such as psychiat-ric patients. This statistical comparison adds objective data not available simply from a clinical interview.
Although clinicians are sometimes frustrated that tests cannot speak specifically enough to the issues involved in child forensic work to dictate definitive answers to legal questions, testing can provide information that augments that gathered from other assessment methods.
Finally, the use of psychological tests permits the examiner to measure and evaluate the subject’s approach to the assessment itself. Understanding an individual’s set or general approach to the evaluation—candor and insight, guardedness and deception, repression and denial—can be essential to accurately evaluating the assessment data as a whole. Some tests, such as the MMPI, used with adults and adolescents (MMPI-2 and MMPI-A, respectively [Butcher and William 1992]), have built-in measures that provide significant informa-tion about whether a subject may be trying to underesti-mate or exaggerate difficulties or may be trying to present himself or herself in a biased manner. Close attention to a child’s approach to testing can provide data regarding whether the child may have been coached or influenced by a parent. For example, in a custody dis-pute, if a child were to give rote answers to every card on the Rorschach (Exner 1995), and these answers all had the theme of a bad man, one might wonder whether the child had been told to make sure that that thought was conveyed. Continuation of this set throughout the inter-view, interaction, and observation portions of the evalua-tion would reinforce this concern.
Choice of Tester
The administration and interpretation of psychological tests require specific training, not only in personality the-ory, psychological development, and psychopathology
but also in test construction and quantitative research methodology. Although some tests can be administered by a technician, the interpretation should not be done by anyone other than a psychologist fully trained and expe-rienced in all of the instruments given. As will be further explained below, responsibility for the interpretation of testing cannot be left to a computer program alone.
Finally, because of important issues regarding role, clini-cians who are providing ongoing treatment to a child should usually avoid evaluating and testing that child in conjunction with a legal proceeding (Greenberg and Shu-man 1997).
When to Use Testing
Many, if not most, child evaluations can benefit from psy-chological testing. Its research base and standardized administration make it particularly useful in forensic set-tings in which clinicians are called on to carefully ground and explicate their findings. Clinicians should be sure to use the most current versions of available tests, as they typically are revised periodically to include up-to-date norms. Properly employed tests can be a useful adjunct to the evaluation, providing information that converges with other sources of information or that raises by itself useful hypotheses to be explored. Following is a list of particular forensic areas, with recommendations of whom to test and what type of questions testing may be of use in answering. More specific information about each type of test is included in a subsequent section of this chapter, “Selection of Tests and Their Relative Utility.”
Abuse and neglect. There are three general areas where testing can be of particular help with questions of abuse and neglect. First, especially in regard to sexual abuse, there are often questions of the reliability of the child’s report. Second are questions of the effects of abuse and neglect on the child. Third, there may be ques-tions pertaining to an adult involved, either as an alleged perpetrator of abuse or in terms of parenting ability in the case of neglect. It is important to note here that although testing should be used with caution in any forensic set-ting, it and other assessment techniques should be used extremely carefully in the area of sexual abuse, in which the focus is often on a question of fact: whether sexual abuse occurred or not. Whatever information it may pro-vide about behavioral traits or conditions, neither testing nor any other clinical assessment technique can provide an actual answer to a question about a fact in dispute.
Case Example 2 shows a situation in which the misuse of testing created serious effects in a custody dispute.
Testing can contribute to judgments of a child’s reli-ability. Intelligence tests can, for example, provide
infor-mation on whether the child is intellectually capable of being able to remember details, understand, and coher-ently report an incident. In addition, knowledge of the child’s intellectual functioning, cognitive and develop-mental level, and view of his or her world can provide a context for the clinician to evaluate the child’s report.
Specific references to abuse are not commonly encoun-tered in the testing situation. However, comparison of less direct themes in the child’s productions with inter-view data can help in assessing reliability. Some of the newer rating scales and personality inventories contain validity scales, which give information about the child’s approach to the test situation.
Testing can also provide information about the effects of abuse and neglect. Physical abuse or neglect can in itself cause decrements in intellectual functioning and learning disabilities. Testing can elucidate these issues, as well as such effects as trauma- or anxiety-induced prob-lems in attention and concentration. Thematic content of some tests can provide data on the effects of abuse.
A sexually abused child who tells more stories than the norm about being physically damaged or terrorized by adults on the Roberts Apperception Test (Roberts 1994) may lead the evaluator to more strongly consider whether serious damage has occurred. Similarly, bland and affectless test responses from a child who suffered abuse may signal maladaptive emotional blunting and withdrawal. Information on the coping styles and inter-personal skills of the child can add important data to the consideration of placement when that becomes neces-sary. With respect to cases in which the adult disputes an allegation of abuse or neglect, testing of the accused adult may have value in contributing to a clearer total picture of the individual, which may be helpful to the trier of fact. It is important to underscore, however, that psycho-logical testing is not capable of identifying the guilty or the innocent or of establishing the credibility or truthful-ness of a person. Any conclusion based on test data that an accused individual is or is not a sexual abuser is a con-clusion that goes beyond the data. As is true of other assessment strategies, there is no reliable test-based pro-file of offenders or any pattern of test results that would indicate truthfulness. Test indications of intentional dis-tortion of the person’s presentation—denial, exaggera-tion, guardedness, or malingering—may shed light on the individual but cannot be brought to bear directly on a question of guilt or innocence.
Termination of parental rights. Evaluation of the adults involved in the question of termination of parental rights is obviously as important as that of the children themselves. Although there is often data in social services
records on both parents and children, frequently a foren-sic evaluation is not considered until very late in the ter-mination process. Often data of a mental health nature are from therapists who are in the difficult position of both treating the child or parent and providing evaluation information for the court or social services. An evaluation that includes concrete information from testing of the presence or absence of character disorder or frank psy-chopathology of the parents, their intelligence and cogni-tive integrity, and their social skills and personality can be of great use to the court. It can help to generate hypoth-eses about a parent’s insight and ability to use psycho-therapeutic or educational and social intervention. Treat-ment issues, goals, and impediTreat-ments may be identified, increasing the likelihood of success when a strategy of intervention is attempted.
In addition, testing the children in cases in which ter-mination of parental rights is at issue can provide infor-mation on their level of functioning and attachment to the parent, which can be woven together with interview, observation, and history to determine whether further contact with the parent would be beneficial or detrimen-tal. The complex question of how the parents’ and child’s temperaments, strengths, and weaknesses interact can be addressed by considering test results. Case Example 1 describes a case in which relatively vague speculations by foster parents and social service workers were initially the only data regarding the psychological function of the children and mother in this case. The testing that accom-panied the evaluation provided information on the chro-nicity of the mother’s problems and her intellectual lim-itations, as well as finding a complexity in the problems of the children that might tax even the most able parent.
This led to the synthesis and recommendation that are reported in the epilogue at the end of the chapter.
Delinquency and criminal proceedings. Testing is fre-quently used in cases of juvenile delinquency commit-ments to identify personality variables, treatment foci, and academic and social skill levels. Assessments are ordered by courts to determine whether adolescents charged with serious felonies, particularly murder and rape, ought to be tried not as juveniles but as adults, sub-ject to the full range of adult sentencing provisions.
Where the binding over of juvenile defendants to adult jurisdictions is not automatic, that is, simply based on factors such as age, provisions for the waiver of juvenile court jurisdiction to an adult court differ across the states. Many considerations taken into account by the courts, such as the seriousness of the offense, the juve-nile’s criminal record, or the welfare of the community, are not assessment questions open to psychological or
psychiatric assessment. Though in practice frequently outweighed by those considerations, juvenile waiver pro-visions commonly involve an assessment of the juvenile’s character and amenability to treatment or rehabilitation in a juvenile facility. On those issues, psychological test-ing can serve as another source of information about per-sonality functioning, insight, and treatment motivation.
At times in particular jurisdictions, questions of com-petency to stand trial, criminal responsibility, and insan-ity are raised in respect to juveniles. Whereas it is debat-able whether adult standards of competency and criminal responsibility are appropriate to juveniles, when juveniles are tried as adults, it is the standard legal tests of compe-tency and insanity that are used. A full discussion of the role of testing in regard to what are essentially adult issues goes beyond the scope of this chapter.
Clinicians and courts may be tempted to use psycho-logical testing as a means to predict the potential for vio-lence or sexual aggression in children and adolescents. To date, no psychological test has been validated for this purpose, and because of statistical problems associated with predicting relatively rare events such as school shootings, as well as a lack of any clear current under-standing of what leads to violence, valid tests of danger-ousness are unlikely to be developed soon. Testing is as problematic in this regard as other clinical predictive methods that have been tried. Using even an instrument that is sensitive to signs of character pathology or aggres-sive conduct, such as the MMPI, specifically for this pur-pose is far more likely to result in false positives—the erroneous identification of youngsters as dangerous—
than accurate predictions.
Child custody. As with termination of parental rights, child custody questions require thorough evaluations of both adults and children, including interview, observation of parent-child interaction, and consideration of testing.
When a dispute has reached an impasse that requires a custody evaluation, parental animosity may be expected to be high, together with concern by the parents that their points of view be fully heard. Testing can contribute to the thoroughness of the evaluation as well as add an objective comparative standard to the process. Testing also enhances the clinician’s ability to compare and con-trast parental strengths and weaknesses in relation to those of their children. Parent rating scales can be com-pared with interview data as a measure of how accurately a parent understands the children. Testing of the children can lend important information about any special needs or problems they have, how children view adult figures, how they perceive the family, and whether and how the divorce process has affected them.
Civil damages. Civil suits brought because of injury to a child have more and more often required the evaluative services of a forensically trained clinician. These can include claims of psychological effects of a physical injury, emotional stress because of disasters or toxic exposure, and psychological trauma resulting from sexual or physi-cal abuse. At times, parents are also named as plaintiffs in these suits. For example, in the case of sexual abuse occurring at a preschool, a parent may enter the suit because of claims of psychological stress caused by having to deal with the trauma experienced by his or her child.
In assessing psychological damage to plaintiffs, test-ing may help identify or rule out preexisttest-ing conditions, which may have continued unchanged or may have been exacerbated by the events in question. Testing can help answer questions of malingering or unreliability, which often need to be considered in situations in which large amounts of money are at stake. Comparisons of current and past testing, when available, can point to changes in psychological functioning.
The intrusion of the traumatic event into test data may indicate how pervasive the response to the injury is.
For example, the boy in Case Example 3, a burn victim, became anxious, tearful, and could not respond to Card IX of the Rorschach, which is frequently seen as smoke and fire, illustrating the claims made on his behalf regard-ing traumatic symptoms. A general picture of personality functioning and coping skills will aid in the difficult task of attempting to predict future effects of the trauma. It is worth considering testing parents of children involved in civil litigation, even if the parents are not named plain-tiffs, although this may not be allowed in some cases.
Research has shown the importance of addressing the aftermath of trauma by adults and institutions (Friedrich 1990). Information on the parents’ functioning as well as that of the children provides a systematic picture of the experience of the family unit. At the very least, appropri-ate parent inventories and child behavior scales should be administered to parents whose children are plaintiffs in civil suits.