Psychological and Neuropsychological Assessment of Children and Adolescents

Sarah A Hall

By Sarah A. Hall, PhD

Psychological and neurocognitive assessment can provide empirical data that can be very valuable to the trier of fact in determining the presence, severity, and absence of psychological and neurocognitive damages in children and adolescents. Testing provided by psychologists who are highly trained and experienced with forensic assessment can be extremely helpful for plaintiff and defense attorneys.

The following items are important aspects of providing evidence-based testimony concerning psychological and neuropsychological testing evaluations of children and
adolescents. Understanding the relevant issues in these complex evaluations can help counsel make more effective and efficient use of test data in cases involving young plaintiffs.

  1. Complete academic records establish the youth’s functioning before and following the target event. Report cards, state-mandated standardized test scores, attendance records, disciplinary records, as well as special education testing and Independent Educational Plans (IEPs) are all valuable sources of data.
  2. Medical records establish the presence or absence of medical problems, injuries, medications, and medical treatments relevant to the issues central to the legal claims that may impact the individual’s functioning. Testing professionals will need to examine relevant aspects of these records as part of a thorough understanding of medical issues relevant when determining test selection, as well as interpretation of neurocognitive and psychological test results.
  3. Psychological records are highly relevant. Psychological factors can impact symptom development, as well as recovery from physical injuries. These records may be part of the youth’s academic and medical records obtained from outside agencies and individual mental health providers.
  4. When the record includes psychological, academic, and neuropsychological testing, “raw data”
    must be obtained from treating and opposing psychological experts, later produced after the tests were administered and scored. The forensic testing expert needs to examine the youth’s actual test responses, the manual scoring, and computerized testing reports that are the basis for conclusions reached in any report. On some occasions, the expert will even rescore the original raw data.
  5. Standardized psychological tests and questionnaires about the youth filled out by parents and caregivers can provide collateral information about current functioning from the parents’ perspective. These tests can also provide an empirically based source of making comparisons between the self-report of the youth and that of their parents.
  6. The use of effort and symptom validity testing is part of the current standard of care for clinical and forensic assessment. Symptom validity tests provide an objective method of assessing symptom exaggeration, embellishment, and along with additional material, may suggest the possibility of malingering of symptoms. Well-designed effort tests help to gauge the level of effort being exerted by the examinee, which also provide evidence regarding claimed levels of impairment. In other words, these tests help the expert assess the credibility of the examinee. The measurement of effort and symptom validity can be given as either “free-standing” tests or be assessed with the use of scales that are embedded within another neurocognitive or psychological test.
  7. The use of projective tests, such as the Rorschach, can provide important, empirically sound data about the psychological functioning of children and adolescents. Traditional paper and pencil endorsement tests offer an opportunity for the young person to describe themselves in a more or less transparent manner. The best of these tests include validity scales that help to assess the likelihood that the individual is responding in a forthright and reliable manner. However, the ambiguous nature of projective testing makes it very difficult for the examinee to judge for themselves the type of information that their responses provide and possibly shape their responses to support their litigation claims. As a result, projective tests allow an opportunity to examine issues in functioning that the examinee may either be reluctant to reveal or may not be aware of themselves. The Rorschach also can provide a cross-check of responses given on “endorsement” tests. The Rorschach-Performance Assessment System (R-PAS), which is the newest scoring and interpretation system for the Rorschach Inkblots, is empirically based, has excellent validity and reliability, as well as updated, international norms.

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