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.
Adults
Intelligence tests. The most common adult intelli-gence test in use today is the Wechsler Adult Intelliintelli-gence Scale—3rd Edition (WAIS-III; Wechsler 1997), although the Stanford-Binet, which has a lower “floor” or more sensitive measurement of impaired intellectual function-ing, is especially useful with the developmentally dis-abled. The WAIS-III, like its counterparts for children, provides measures of a variety of abilities taken to be associated with what is commonly referred to as intelli-gence. It especially assesses abilities important to aca-demic and occupational achievement, rather than for social skills and creativity, and a variety of specific intel-lectual capabilities. Cognitive impairment of various types can be identified in WAIS-III performance, as can areas of strength and comparative skill. Many psycholo-gists tap the WAIS-III for useful information regarding personality factors, which is similar to the information obtained from projective testing. Although the Wechsler can be helpful in this way, tests of intelligence would usu-ally not be administered unless there was some concern about the adult having an intellectual deficit or significant cognitive impairment.
Personality inventories. Well-researched personality inventories are very commonly given; they have consider-able reliability and provide quantified results that may be readily interpreted in light of published norms. Such tests are “paper-and-pencil” instruments that require endorse-ment by the subject of various stateendorse-ments pertaining to beliefs, emotions, and behavior, for example, by marking them true or false or by rating their applicability to the test subject. Among the instruments developed for use with nonclinical populations are the California Psycho-logical Inventory (Gough 1987), the Sixteen Personality Factors Questionnaire (Cattell et al. 1993), and the NEO PI—Revised (Costa and McCrae 1992). The MMPI-2, for some years the most commonly administered psycho-logical test, is designed to assess significant functional dis-orders in the neurotic, characterological, and psychotic spectra but is also sensitive to subclinical personality fac-tors or traits. The Millon Clinical Multiaxial Inventory—
3rd Edition (Millon 1994) was specifically designed to assess DSM-IV (American Psychiatric Association 1994) personality disorders, although it is normed on individu-als who are in the early stages of treatment and may pro-vide an overestimate of problems in other populations.
The Personality Assessment Inventory is also being increasingly used to assess adult psychopathology.
Although they are often called objective tests, the personality inventories, no less than other tests, require
clinical skill to use and are therefore susceptible to some subjectivity in interpretation. Undue reliance on the score profile from such instruments in reaching diagnos-tic conclusions, let alone recommendations on matters such as custody or sexual abuse, without considering the psychometric properties of the instruments together with a variety of data obtained elsewhere, invites error.
The instruments are objective in the relative sense that they sharply reduce subjective factors, particularly those produced in the interaction between examiner and sub-ject, which are present in other assessment methods.
Although somewhat time-consuming for subjects to complete, they allow for efficient and inexpensive use of examiner time.
Projective tests. Projective tests require responses by the subject to ambiguous stimuli. A wide variety of such instruments have been developed, though few are in common use currently. The Rorschach inkblot technique is perhaps the best known and most widely used of these instruments; 10 cards are presented in sequence to the subject, who is asked to indicate what the inkblots on the cards might be; inquiry follows as to where on the card the percept was seen and what made it appear to the sub-ject in the way that it had. It can provide information on psychopathology or its absence. It is also used to examine the subjects’ usual response or coping style, how they approach ambiguous situations, and how emotions are handled. Comparison of the Rorschach summaries of var-ious members of a family can help generate hypotheses about how the styles of various members might interact with those of others in the family.
Most clinical psychologists view projectives as adding information to the examination not otherwise available.
Unlike the self-report inventories, the manifest content of projectives gives little clue as to what a “good,” or desirable, response might be.
This aspect of these techniques is particularly valu-able in forensic settings in which subjects are not dis-interested in the outcome and recommendations and in which they may feel strong needs to present themselves in particular ways. Projectives also permit an observation of a subject’s response to an ambiguous and unfamiliar task.
Projective tests vary in the extent to which they have been subjected to the empirical study of their psycho-metric properties. Generally, when examined, such instruments appear to have, relative to the “objective”
personality measures of tests of ability and aptitude, poor reliability and uncertain validity. These problems are sometimes compounded by the lack of standardization in administration, scoring, and interpretation. As test
instruments, projective techniques are more vulnerable than other types of testing to examiner error and bias, because they typically require a great deal of subjectivity in interpretation, if not in scoring and administration.
Used carelessly, they may be more tests of the examiner than of the subject. In the case of the Rorschach at least, considerable work has been done by Exner and his asso-ciates (Exner 1995) on improving standardization and reliability, quantifying scoring, and identifying from empirical research personality and behavioral correlates of test data; as a result, Exner’s Rorschach shares more in common with objective personality instruments than do other projectives. Tests such as the Thematic Appercep-tion Test (Murray 1971), Draw A Person techniques (Goodenough and Harris 1950), and non-Exner Ror-schach systems (Exner 1995), although perhaps useful in some types of assessments, lack the psychometric prop-erties necessary for forensic evaluation and are thus not recommended for use, especially in light of the availabil-ity of other more rigorous measures.
Parenting inventories. If parental attitudes and abili-ties are in question, such as in child custody and parental fitness evaluations, there are psychometrically valid instruments available to aid in such an assessment (Heinze and Grisso 1996). The Parent-Child Relation-ship Inventory (Gerard 1994) assesses parental attitudes toward parenting and their children. Data are obtained regarding the similarity of the parent’s responses to those parents who display attitudes consistent with good parenting. The Parenting Stress Index (Abidin 1995) aids in the identification of potentially stressful parent-child relationships by screening for reported parental stress.
The Child Abuse Potential Inventory (Milner 1986) was developed in order to assess a parent’s risk of physically abusing a child. It measures a set of risk factors that are compared to norms of parents who have physically abused their children.
Children
Intelligence and adaptive behavior. Intelligence test-ing for children can be helpful even if there is no question of serious intellectual difficulties. This testing can give significant information about the child’s cognitive abili-ties, especially his or her ability to understand the current legal or familial situation, to report events accurately, or to interpret events. The Wechsler Intelligence Scale for Children—3rd Edition (WISC-III; Wechsler 1997), the Wechsler Preschool and Primary Scales of Intelligence—
Revised (WPPSI-R; Wechsler 1989), and the Kaufman batteries (Kaufman and Kaufman 1983) are most com-monly used. For very young children, the Bayley Scales of
Infant Development—2nd Edition (Bayley 1993) and the Miller Assessment for Preschoolers (MAP; Miller 1982) are available. Inventories such as the Vineland Adaptive Behavior Scales (Sparrow et al. 1984) use structured interviews to help determine the functioning level of developmentally disabled children.
Personality inventories. There have been several per-sonality inventories developed in recent years that are geared to children. These have similar advantages to adult inventories in that they have scales that provide informa-tion on the child’s approach to the test itself, as well as the ability to compare scores with nonclinical and psychi-atric normative populations. The MMPI-A is available for teenagers 14 years or older, and the MCMI-III has its counterpart in the Millon Adolescent Clinical Inventory (Millon 1993). For younger children, the Personality Inventory for Children (PIC; Lachar 1989) and the Behavior Assessment System for Children (BASC; Rey-nolds and Kamphaus 1990) are inventories with reading levels and norms for children ages 8 through 18.
As most clinicians are aware, children are not always the most accurate reporters of their emotional state and behaviors. To supplement children’s reports, there are a number of instruments available that allow parents and others to report. The PIC has a counterpart, the Person-ality Inventory for Youth (Lachar and Gruber 1995), which is completed by parents regarding their children.
In addition to parent rating scales, the BASC also includes scales for teachers. The scales can be integrated to form a comprehensive picture of the child. Although it does not have validity scales, the Child Behavior Checklist (Achenbach 1991) can be useful in making comparisons of the way each parent in a custody dispute, for example, sees the children and the extent to which this may or may not coincide with the evaluator’s hypotheses about the children. Parents in custody dis-putes may be quite discrepant in their views of the chil-dren, and both may underestimate the effect of the dis-pute on their children. In other situations, such as termination of parental rights, the scales can be com-pared to those filled out by teachers and other significant adults such as foster parents. In cases of civil damage, comparisons of ratings by parents or others may indicate the reliability with which certain features of behavior appear. This type of concrete information about the par-ents’ own assessment of their children and how it relates to those of others can be an asset in making recommen-dations.
Projective testing. Discovering how children, espe-cially young children, feel and think about events in their lives is not an easy task. In forensic evaluations the issue
is particularly sensitive. Most would agree that it is not appropriate to directly ask young children about their preference for one parent or the other in a custody eval-uation or to ask leading questions in an evaleval-uation of sex-ual abuse. Most children, no matter their age, are exquis-itely aware of why they are being evaluated and may feel anxious about what they say to an evaluator in light of how it may affect their parents or the decision of the court. Projective testing provides a forum a step removed from direct discourse and can skirt a child’s conscious intentions and permit reasonable inferences about the child’s needs and fears. Case Example 3 shows how test-ing can reveal serious difficulties in a child who is uncom-fortable in an interview situation.
As mentioned above, poorly validated child projec-tive tests, such as the Children’s Apperception Test (Bel-lak 1986), should be avoided in child forensic evalua-tions. An Exner Rorschach , however, will give information about a child similar to that previously men-tioned in regard to adults. Validated projectives, such as the Roberts Apperception Test for Children (RAT-C;
Roberts 1994) and the Tell Me a Story Test (Costantino et al. 1988), are particularly useful in forensic cases. Both tests have children make up stories about sets of pictures representing typical situations and possible problems in child and family life. The tests are then quantitatively scored and compared with a general population of chil-dren.
Projective drawings are sometimes used by clini-cians. Great care should be taken in the selection and especially the interpretation of drawings. As is the case with adults, it has been charged that tests such as the Draw a Person (Goodenough and Harris 1950) are too far removed from the referral question and too indefen-sible in court to be of much utility. However, the Kinetic Family Drawing (Burns 1982), which asks the child to draw a picture of his or her family doing something, appears to be quite directly related to the issues involved in much child forensic work. How the child describes the picture and answers questions about it may provide use-ful clinical information, even if it does not yield test scores comparable to normative values. Who is and is not included in the picture, the activity depicted, and the interaction among family members may help generate hypotheses about the child’s view of the family. For younger children, there are a number of structured play techniques in the literature (e.g., Gardner 1982; Lynn 1959, as found in Palmer 1983), which take the child though a series of vignettes, during which the type of play is observed and noted. It is important to note that these techniques are not psychological tests. They may indeed be more properly considered as clinical observation tools.
Inferences made from a child’s performance on these tasks must be very cautiously made and be integrated with interview and other observational data. It would be inappropriate to base important conclusions or recom-mendations solely or largely on such inferences.
Tests of academic functioning. It is often helpful to determine whether and how a child’s school performance has been affected by events at issue. The Wide Range Achievement Test—3rd Edition (Wilkinson 1993) and the Wechsler Individual Achievement Test—II (Wechsler 2001) are quick tests of such basic areas as reading, spelling, and mathematics skills. For a broader picture of a child’s academic abilities, the Woodcock-Johnson Psychoeducational Battery—Revised (Woodcock and Johnson 1989) provides data on a number of skills in rela-tion to the child’s age and grade level. With these tests, the evaluator can determine a child’s academic rank rela-tive to peers and can use this information in conjunction with the intelligence scales and teacher and parent reports to look at overall adaptation of the child. There are also numerous tests related to specific learning dis-abilities that can be used if indicated.
Neuropsychological testing. In some cases, such as personal injury cases involving head trauma or toxic tort litigation, tests of the child’s memory and other neuro-psychological functioning may be required. Selected tests or comprehensive batteries, such as the Halstead-Reitan Neuropsychological Test Batteries for Children (Reitan and Davison 1974) and the Nebraska Neuropsychological Children’s Battery (Golden 1986), are often used. Spe-cific tests of memory in children have only recently been designed. These include the Children’s Memory Scale (Cohen 1997) and the Test of Memory and Learning (Reynolds and Bigler 1994).
Attention-deficit/hyperactivity disorder (ADHD) is a differential diagnostic question that occurs with some regularity in forensic evaluations of children. There are a number of tests and rating scales that can be of use in screening for ADHD. The Test of Variables of Attention or Connors’ Continuous Performance Test are computer-ized assessments of the ability of a child to pay attention.
The revised Conners’ Rating Scales and a number of scales developed by Barkley (1998) are typically used in the assessment of ADHD.
Tests addressing specific forensic issues. There are several specific issues that frequently arise in child foren-sic evaluations that have been addressed by equally spe-cific tests. The Trauma Symptom Checklist for Children (Briere 1996) is a self-report instrument that purports to measure posttraumatic stress in children. The Child
Sex-ual Behavior Inventory (Friedrich 1997) is a parent-report measure that compares the behavior of the child being assessed to normative sexual behavior of children of the same age. Whereas both of these inventories are psychometrically sound and have validity scales, they should be carefully used in the forensic arena because they are quite “face” valid, with “open content.” Unlike the MMPI or the Rorschach, for example, what the test purports to measure may be quite obvious to the test-taker. Thus, these measures may be somewhat more vul-nerable to exaggeration or to defensiveness by a plaintiff who may have an interest in presenting a certain way. The validity scales incorporated into the instrument may not identify particular instances of response bias related to litigation. This is even truer for simple checklists, which are sometimes misleadingly called tests. Most checklists have no validity scales and are highly susceptible to deceptive responding by subjects in forensic evaluations.
There have been other efforts to develop tests that are designed specifically for use in child custody evalua-tions. The Bricklin Scales (Bricklin and Elliot 1997) and the Ackerman-Schoendorf Scales for Parent Evaluation of Custody (Ackerman and Schoendorf 1992) are exam-ples of this genre. Although such scales invite strong and even exclusive reliance by examiners and the court on their results, empirical research to date does not justify such reliance, and none can be recommended as substi-tutes for full consideration of the wide variety of data obtained in standard evaluations.
The prosecution of youngsters, both as juveniles and adults, is an emerging issue. To date, instruments addressing competency to stand trial that are valid for youth offenders are not available. Grisso’s Instruments for Assessing Understanding and Appreciation of Miranda Rights (Grisso 1998) are based on research with children as young as 10. The Grisso Miranda Instruments are not designed to yield an overall score and do not pur-port to actually measure competency to waive Miranda rights; however, they can be a useful adjunct to an evalu-ation of this competency.
Interpretation of Test Data
The results of psychological tests do not stand alone but must be carefully interpreted in light of the information obtained in the rest of the evaluation. Test interpretation is inherently inferential, and care should be taken to stay as close to the actual data as possible. Although it may be interesting to make wide-ranging dynamically oriented hypotheses about test responses when evaluating a per-son for treatment planning, it is inappropriate to do so in the forensic arena where the evaluator must be able to
clearly account for the basis on which conclusions and recommendations are made. Speculations about repressed Oedipal content as seen on the Rorschach are much less helpful to the court than clear statements about how such a conflict may be expressed in personal-ity style, behavior, and parenting abilities. Misidentifying remote and speculative inferences from testing as find-ings and indications may be seen as a misuse of testing and a disservice to the individuals affected. The examiner bears grave responsibility for affecting the lives of others and must strive to ground recommendations in actual data rather than speculation.
Integration With Other Evaluation Data
In Case Example 2, the psychologist has made an impor-tant error in interpretation. He has taken several isolated responses from the test data and has extrapolated from them evidence of sexual abuse. There is no single response on any test instrument that warrants such an accusation; test data need to be considered as a whole, and individual responses have little significance by them-selves.
Interpretations of test responses should not go beyond what the tests themselves can measure. In a thor-ough evaluation, each test should be carefully scored and interpreted. The information gained from the tests should be integrated into hypotheses about persons and how they interact with one another, if that is relevant to the legal question. These hypotheses can then be consid-ered in light of the other data from the evaluation, including document review and clinical interview. Inter-pretive hypotheses from testing can help objectively con-firm what the clinician has found and enrich an under-standing of otherwise unexplained facts. They serve also to point out discrepancies or other avenues to pursue. As can be seen in Case Example 1, testing indicated that the mother could have substance abuse problems. This led the psychologist to interview her in depth about drug abuse, which she then admitted. Rather than simply reporting an inference from test data, the psychologist now had clear, direct evidence that could be used in her report.
Use of Computer-Scored Interpretation
Many psychological tests have computer programs avail-able that not only score them but also provide clinical interpretations based on the test data. It may be tempting for the clinician not trained in testing or psychometrics to consider these printouts a finished interpretation and include them verbatim in reports without further inves-tigation. As most manuals for these tests point out, this is