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Evaluating Adaptive Functioning Deficits�Prong-2

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Antonio E. Puente, PhD

University of North Carolina Wilmington

�(with assistance Juan A. Serrano, PsyD)

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MCLAP Meeting

San Antonio, TX

May 16, 2024

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Preamble

The information contained in this presentation does not reflect the policy of APA, any division of APA, APA Psychological Services, NAN, or any state psychological or specialty association. Further, this information is intended to be informative. It does not supersede APA or state provincial licensing boards, ethical guidelines, and/or local, state, provincial, or national regulations and/or laws. This is a living document that can and will be revised as additional information becomes available. The ultimate responsibility for the validity, utility, and application of the information contained herein lies with the individual and/or institution using this information and not with any supporting organization and/or the author of this presentation. Suggestions or changes should be addressed directly addressed to the author. Note that whenever possible, references are provided. The information provided serves as a source of education to the readers of the materials contained or attendees at this presentation and is not intended for public distribution. Thank you

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�OUTLINE

  1. BACKGROUND
  2. DEFINITION OF INTELLECTUAL DISABILITY (ID)
  3. ASSESSMENT OF ADAPTIVE BEHAVIOR– PRONG 2
  4. BEST PRACTICES
  5. CHALLENGES
  6. FUTURE DIRECTIONS

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�OUTLINE

  1. BACKGROUND
  2. DEFINITION OF INTELLECTUAL DISABILITY (ID)
  3. ASSESSMENT OF ADAPTIVE BEHAVIOR– PRONG 2
  4. BEST PRACTICES
  5. CHALLENGES
  6. FUTURE DIRECTIONS

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ROGER W SPERRY�NEUROPSYCHOLOGY LABORATORY���

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Status

Individuals

Post-doctoral Fellow & Visiting Scientists

Juan A. Serrano-Salcedo, PsyD,

Jessica Forde, PhD & Antonio N. Puente, PhD

Graduate Student

Kate E. Carlson

Post-Bachelor’s (College)

Marla Allen

Undergraduate Students

Andy Ontiveros, Nicole Aragon

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Roger W. Sperry�(rogersperry.org)

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Alexander Luria

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�OUTLINE

  1. BACKGROUND
  2. DEFINITION OF INTELLECTUAL DISABILITY (ID)
  3. ASSESSMENT OF ADAPTIVE BEHAVIOR– PRONG 2
  4. BEST PRACTICES
  5. CHALLENGES
  6. FUTURE DIRECTIONS

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Definition of ID

Standards for ID diagnosis: �

    • American Association for Intellectual and Developmental Disability (AAIDD, 11th and 12th Editions)

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    • Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association (DSM, 5th edition and 5-TR Editions)

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    • International Classification of Diseases by the World Health Organization (ICD, 10th and 11th Editions)

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Definition of ID

Three criteria or prongs: �

Prong 1- An intellectual ability that is two standard deviations or more below the population (70).

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Prong 2- Significant impairments in adaptive functioning.

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Prong 3- Both of these must be presented prior to the age of 22.

(AAIDD, 2021).

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Adaptive Behavior

Critical:

  • Before age 22
  • Ecologically valid setting.
  • Collaterals: Knowledge of US cultural values and knew the person before age 22.

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Additional:

  • How well a person meets community standards of personal independence and social responsibility in comparison to others of similar age and socio-cultural background (DSM-5 TR).
  • Is actual performance, not ability or potential.
  • Importance of a socio-historical-cultural context.

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Conceptual Skills

Social Skills

Practical Skills

Domains of Adaptive Behavior

(AAIDD, 2021)

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Areas of Adaptive Behavior

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(AAIDD, 11 & 12th Edition)

(AAMR, 10th Edition)

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�OUTLINE

  1. BACKGROUND
  2. DEFINITION OF INTELLECTUAL DISABILITY (ID)
  3. ASSESSMENT OF ADAPTIVE BEHAVIOR– PRONG 2
  4. BEST PRACTICES
  5. CHALLENGES
  6. FUTURE DIRECTIONS

​

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Assessment of Adaptive Behavior #1

  • Standardized adaptive behavior tests.
  • Individualized, culturally appropriate, and psychometrically sound.
  • Test that have been translated, adapted, and normed in Spanish (lack of).�

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Assessment of Adaptive Behavior #2

Other sources, such as: �

    • Direct observation.
    • Review of record:
      • School records.
      • Medical records.
      • Previous psychological evaluations.
      • Vocational record
    • Collaterals interviews.

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(AAIDD, 11th Edition)

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Assessment of Adaptive Behavior #3

  • Sensitive to language differences and culture (AAIDD, 11th Edition).

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  • Difficulties in respondents to appreciate the cultural reference point.�
  • “Use clinical judgment to guide the evaluation of the reliability of information provided by respondents...” (AAIDD, 11th Edition, p. 48). �

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Fairness in Testing

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“Accessible testing situations are those that enable all test takers in the intended population, to the extent feasible, to show their status on the target construct(s) without being unduly advantaged or disadvantaged by individual characteristics (e.g., characteristics related to age, disability, race/ethnicity, gender, or language) that are irrelevant to the construct(s) the test is intended to measure.” (AERA, et al., 2014, p.52).

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“Validity and reliability/precision considerations are paramount, but the demographic characteristics of the group(s) for which the test originally was constructed and for which initial and subsequent normative data are available also are important.” (AERA et al., 2014, p. 152)

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Standard 10.5:

    • Tests selected for use in psychological testing should be suitable for the test taker's characteristics and background (AERA et al., 2014, p. 165).

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Test Selection

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Examples of Tests Used to Evaluate �Adaptive Behavior in English/Spanish

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English/Spanish:

    • Adaptive Behavior Assessment System, Third Edition (ABAS™-3)
      • Ages: Birth to 89

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    • Vineland Adaptive Behavior Scales (Vineland-3)
      • Ages: Birth to 90

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�OUTLINE

  1. BACKGROUND
  2. DEFINITION OF INTELLECTUAL DISABILITY (ID)
  3. ASSESSMENT OF ADAPTIVE BEHAVIOR– PRONG 2
  4. BEST PRACTICES
  5. CHALLENGES
  6. FUTURE DIRECTIONS

​

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Best Practices

  • Individually administered scales normed on the general population (US

and other).

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  • Respondents:
    • Adaptive behavior is typical behavior, not maximal behavior.
    • Rating based on direct observation.
    • Observed the behavior across multiple ecological valid contexts.

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  • Considering Standard Error of Measurement – 95% Confidence Interval.

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  • Comprehensive assessment: multiple sources, collaterals, and records.

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  • Before age of 22 vs. after 22.

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(AAIDD, 12th Edition)

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Standard Error of Measurement (SEM)

  • SEM = an estimate of error or imprecision in IQ score.

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  • Range IQ score using a 95% confidence interval.

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  • Typical SEM is around 3-5 points (example next slide).

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Normal Distribution Bell Curve

Score: 70

95% C.I: 67-73

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�OUTLINE

  1. BACKGROUND
  2. DEFINITION OF INTELLECTUAL DISABILITY (ID)
  3. ASSESSMENT OF ADAPTIVE BEHAVIOR– PRONG 2
  4. BEST PRACTICES
  5. CHALLENGES
  6. FUTURE DIRECTIONS

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Test and Norm Selection

Efforts should be made to select tests and norms that:

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    • Close to meeting recognized scientific standards of validation.
    • Representative of the population with whom they are being used.
    • Follow standards of translation and adaptation.

(Judd et al., 2009)

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Using a Translator

  • Decrease errors by matching the examinee with evaluator's native language.�
  • Sources of error: rapport, validity of test results, adaptation, distractibility, norm interpretation, and construct equivalence.

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  • Translators can affect rapport, communication, and validity (Tassé, 2009).

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  • Inconsistent with testing environment being free from distractions (NAN, 2000).

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  • 3rd party introduces an unknown variable and prevents valid comparisons (NAN, 2000).

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Translating Tests

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  • Does not produce scores that are equally reliable/precise and valid.

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  • Lack of evidence:�
    • Validity
    • Reliability/precision
    • Comparability of scores
    • Construct equivalence

� (AERA, et al., 2014)

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Adaptive Assessment Challenges

  • Ecological valid functioning.

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  • Structured and non-ecological valid settings (e.g., prison.

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  • Learning of the dominant culture.

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  • Trusted sources.

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  • Collateral’s knowledge of cultural values of the US and of the person before age 22.

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Puente Practices

  • Rationale for Mitigation Information.
  • Approaches to Mitigation Gathering and Mitigation Specialists.
  • Methods of Mitigation Gathering.
    • Virtual vs. In-Person.
    • Selection of Collaterals.
    • Selection of Prong 2 Portions to Emphasize.
    • Location of Interviewing.
    • Clinical Interviewing Techniques.
    • Psychometric Data.
    • Presence of Third Party Observers.
  • Focus on the Socio-Historical-Cultural Context.
  • Integrating Records, History, Qualitative, and Quantitative Data.

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Prosecutorial Challanges

  • Prong 1 vs Prong II.
  • Retrospective Analysis.
  • Lack of Tests.
  • Norms.
  • Comparison to Native vs. US References/Norms.
  • Limited, if any, Quantitative Data.
  • Reference Situations and Samples.
  • Misunderstanding or Disbelief of Socio-Historical-Cultural Context.
  • Dr. Death’s Assessment Approaches.
  • Dr. Death’s Interpretation of Variables Producing IQ.

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�OUTLINE

  1. BACKGROUND
  2. DEFINITION OF INTELLECTUAL DISABILITY (ID)
  3. ASSESSMENT OF ADAPTIVE BEHAVIOR– PRONG 2
  4. BEST PRACTICES
  5. CHALLENGES
  6. FUTURE DIRECTIONS

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An Alternative Paradigm

Division 52, International Psychology,

American Psychological Association

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Seeks to develop a science that is contextually informed, cultural

inclusive, serves the public interest, and promotes global perspectives

(within and outside of APA).

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Antonio E. Puente

President, 2022-2023

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Minnesota Neuropsychology Conference: Diversity, Equity, & Inclusion Aspirations

  • Demonstrate cultural humility and respect; understand culture’s impact on all professional activities; be aware of intersectional identities and associated inequities; be aware of historical and institutional inequities; and advocate for marginalized and/or minoritized individuals, populations, and perspectives, traditionally defined by differing ability levels, ethnicity, gender, sexual orientation, and other social and economic constructs.

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Minnesota Assessment Definition

  • Conduct culturally-informed neuropsychological evaluations. Use tests and procedures, including measures developed with innovative methods and technologies, that are evidence-based, reliable, valid, and culturally and normatively appropriate. Develop diagnostic case conceptualizations and interpretations that consider ethnicity, language, education level and quality, literacy, gender, sexual orientation, disability status, and other identities and their intersectionality. Utilize tests and procedures, including measures developed with innovative methods and technologies, that are evidence-based, reliable, valid, and culturally and normatively appropriate...

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Neuro/Psychological Methodology

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  • Sperry
    • Upward/Downward Causation
    • Quantitative
  • Luria & Vygotsky
    • Socio-historical-cultural context
    • Qualitative
  • Hybrid
    • From bottom to top/From right to left
    • Scientific & Socio-historical-cultural integration
    • “Romantically scientific”

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Information

    • Vita/ Academic: antonioepuente.com
    • Clinical: clinicalneuropsychology.us

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antonioenriquepuente@gmail.com

clinicalneuropsychology@gmail.com

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Resources

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References

  • American Educational Research Association, American Psychological Association, & National Council on Measurement in Education (Eds.). (2014). Standards for educational and psychological testing. American Educational Research Association.�
  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596�
  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787�
  • Axelrod, B., Barth, J., Faust, D., Fisher, J., Heilbronner, R., Larrabee, G., Pliskin, N., Silver, C., & Policy and Planning Committee, National Academy of Neuropsychology (2000). Presence of third party observers during neuropsychological testing: official statement of the National Academy of Neuropsychology.  Archives of Clinical Neuropsychology, 15(5), 379-380.

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  • Judd, T., Capetillo, D., Carrión-Baralt, J., Mármol, L. M., Miguel-Montes, L. S., Navarrete, M. G., Puente, A. E., Romero, H. R., Valdés, J., & NAN Policy and Planning Committee (2009). Professional considerations for improving the neuropsychological evaluation of Hispanics: a National Academy of Neuropsychology education paper.,Archives of clinical neuropsychology. 24(2), 127–135.

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  • Luckasson, R., Borthwick-Duffy, S., Buntinx, W. H. E., Coulter, D. L., Craig, E. M. (P.), Reeve, A., Schalock, R. L., Snell, M. E., Spitalnik, D. M., Spreat, S., Tassé, M. J., & The AAMR AD HOC Committee on Terminology and Classification. (2002). Mental retardation: Definition, classification, and systems of supports (10th ed.). American Association on Mental Retardation.

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References (continued)

  • Schalock, R. L., Borthwick-Duffy, S. A., Bradley, V. J., Buntinx, W. H. E., Coulter, D. L., Craig, E. M., Gomez, S. C., Lachapelle, Y., Luckasson, R., Reeve, A., Shogren, K. A., Snell, M. E., Spreat. S., Tassé, M. J., Thompson, J. R., Verdugo-Alonso, M., Wehmeyer, M. L., & Yaeger, M. H. (2010). Intellectual Disability: Definition, classification, and systems of supports (11th ed.). American Association on Intellectual and Developmental Disabilities.

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  • Schalock, R. L., Luckasson, R., & Tassé, M. J. (2021). Intellectual disability: Definition, diagnosis, classification, and systems of supports (12th ed.).American Association on Intellectual and Developmental Disabilities.

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  • Tassé M. J. (2009). Adaptive behavior assessment and the diagnosis of mental retardation in capital cases. Applied neuropsychology, 16(2), 114–123. https://doi.org/10.1080/09084280902864451

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  • World Health Organization. (2016). International statistical classification of diseases and related health problems (10th ed.). https://icd.who.int/browse10/2016/en

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  • World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/

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