NLBC LEGAL UPDATE: January, 1998 - Issue #1

Sam Goldstein, Ph.D., Editor. Complimentary Service of the Neurology, Learning and Behavior Center

REVIEW #1 Accuracy of Self-Reported Educational Attainment Among Diverse Patient Populations: A Preliminary Investigation. Green, D.J., Dehring, M., Adams, K., Miller, T., Arora, S., Beylan, A. & Brandon, R. (1997). Archives of Clinical Neuropsychology, 12, 635-643. There has long been speculation concerning the accuracy of self-reported information, particularly from certain patient populations involved in litigation. Of importance is the use of this information in estimating pre-trauma functioning in a number of areas, including intelligence. These authors examined 116 individuals with diverse diagnoses, including alcoholism, Post Traumatic Stress Disorder, schizophrenia and dementia to determine the accuracy of self-reported high school educational attainment. Results suggested that at least half of all participants were inaccurate as defined by discrepancies between actual and estimated grade point average greater than .5 on a traditional four point grading scale. Most individuals were inaccurate in the direction of over-estimating their educational attainment. Patients diagnosed with alcoholism and Post Traumatic Stress Disorder were significantly less accurate in recalling their educational history when compared to a group of normal control subjects. At the extreme, several subjects whose records could not be verified were found to have not attended high school as they had claimed. Neuropsychological/Legal Implications Neuropsychologists in the legal arena are increasingly being requested, based upon post-accident or trauma assessment, to estimate the degree or percentage of loss in a variety of areas, including intellectual skills. Among the increasingly popular means of estimating pre-trauma intelligence are formulas relying upon pre-trauma educational scores. In many situations transcripts are not obtained but scores are reported to evaluators by the litigant. This study underscores the importance of obtaining accurate records if in fact estimates of loss of intellectual ability are going to be made. In the absence of the examination of such records, a neuropsychologist providing estimates of loss of ability is as likely to be incorrect as correct in those estimations.

REVIEW #2 Reynolds, C.R. (1997). Post-scripts on pre-morbid ability estimation: Conceptual agenda and a few words and alternative and conditional approaches. Archives of Clinical Neuropsychology, 12, 769-778. The estimation of pre-morbid ability levels has been debated for some time. This issue has become increasingly more volatile as such estimates are often used to define the extent of cognitive and related functional loss secondary to trauma in litigation situations. This article reviews many of the difficult issues involved in estimating pre-morbid ability. It provides a review of the more popular approaches, including best performance estimates, hold/don't hold tests, demographic estimations, familial data and formula generated from post-trauma testing. Many of these estimation systems are popular for reasons of convenience and false beliefs of their accuracy. For example, demographic estimation procedures in particular tend to fare worse than believed in some research. This article is but one of an entire issue of this journal devoted to articles dealing with this subject. Neuropsychological/Legal Implications Given that neuropsychologists will continue to be asked to estimate loss of cognitive and related skills, as well as functional ability it appears prudent and reasonable to conclude that the best methods for drawing such conclusions are actual standardized test scores from pre-morbid assessments, including, if available, individual or group I.Q. tests, achievement tests administered during the school years, college entrance exams and report cards. In the absence of these data, estimates can be computed statistically based on demographics and family history. When current performance data are used in estimations there is a strong possibility they may either over- or under-estimate pre-trauma functioning. Thus, these estimations, if used at all, should be approached with great caution.

REVIEW #3 Goldstein, S. (1997). Attention Deficit/Hyperactivity Disorder: Implications for the Criminal Justice System. F.B.I. Law Enforcement Bulletin, 66, 11-16. Interaction between the mental health and criminal justice professions traditionally occurs over issues such as a defendant's claim of temporary insanity or overt mental disorders exhibited by criminal defenders. Recently, however, professionals in these two fields have begun to explore a broader range of behavioral disorders, particularly Attention Deficit Hyperactivity Disorder, both as a mitigating factor and possible explanation for criminal and related behavior. The importance of this issue in the legal arena is quickly coming to the forefront with a recent state Supreme Court decision reversing a murder conviction because experts were not allowed to testify as to the relevance of ADHD upon a confession. This article provides a thorough overview of the current field of ADHD throughout the adult years as well as reviewing issues, including courtroom accommodations, ADHD as a defense, factors related to sentencing, incarceration and rehabilitation.

REVIEW #4 Gasquoine, P.G. (1997). Postconcussion Symptoms. Neuropsychology Review, 7, 77-85. This review article comprehensively examines the literature on self-reported symptoms following traumatic brain injury. The author concludes that cognitive, emotional and motivational factors appear to have more relevance in determining symptom complaints than the majority of demographic and personality factors. Specific neurological deficits in the areas of attention and memory are consistently reported in the literature in the early stages following head injury of even mild severity. However, it is concluded that it is not likely that these are the only two factors that affect symptom persistence. The author further concludes that although exaggeration of cognitive dysfunction occurs in some cases, it appears generally unrelated to symptom over-report. Increased emotional distress typically accompanies symptom persistence. The psychological reaction of preoccupation with symptoms and emotional distress is also reported as not unique to just concussion but reported to occur after a variety of other injuries and may relate more to personal interpretation of the effect of the trauma than to objective indicators of brain injury severity. Neuropsychological/Legal Implications A comprehensive neuropsychological assessment combined with the behavioral pre- and post-injury measures from relatives, employers and significant others remains the most effective means of investigating the relative contribution and interaction of myriad factors in determining self-report of cognitive, emotional and physical symptoms. It is increasingly recognized that a small group of individuals experiencing an as yet incomplete set of contributing factors appears at risk to develop severe and multiple symptomatic problems in the face of what initially presents as a seemingly mild head injury. Attorneys should recognize that after trauma, preoccupation with symptoms has been correlated with heightened emotional distress and this reaction appears unrelated to specific injury to the brain. Although there is a need for much more research in this area, the recognition that more than just physical sequelae contribute to symptom report, severity and persistence is increasingly being recognized. The Neurology, Learning and Behavior Center provides multi-disciplinary assessment, case management and treatment services for children and adults with brain injury and dysfunction, Attention-Deficit Hyperactivity Disorder, language disorders, learning disability, developmental delay, emotional disorders and adjustment problems. The Center is dedicated to the provision of treatment services.