Forensic psychology: Part 4: Chapter 11: Assessing offender populations

by Gary W. Fischer, Ph.D., C. Psych.^{Footnote 1}

Objectives

1. To identify specific referral concerns for neuropsychological evaluation.
2. To provide guidelines to focus europsychological assessment and intervention.

Neuropsychology studies the relationship between brain dysfunction or damage and the behavioural, social or emotional consequences resulting from this damage. The incidence of brain impairment and learning disability is found to be higher in a correctional setting than in the general population. Consequently, a high proportion of offenders present with a deficit pattern. These cognitive processing limitations affect an offender's adjustment to incarceration, ability to benefit from programming and treatment, and interactions with others. An offender's vocational and educational aptitude may also be affected.

Neuropsychological deficits can arise from a variety of traumas, including pregnancy/birth complications, head injury, substance abuse, exposure to toxins, and as a consequence of disease. Typically, deficits will affect an individual's capacity to learn new information and to apply that information in current situations. Impairments in offenders are often detected in their levels of attention and concentration, memory, abstract reasoning, visual spatial/ perceptual organization, and in motor coordination. Depending upon the type of deficit, or region of the brain affected, specific patterns of cognitive processing strengths and weaknesses are observed.

Given that brain dysfunction results in learning difficulties and difficulties in applying learned information, identifying offenders with brain dysfunction can allow for correctional programming to be modified to take these impairments into account.

Neuropsychology constitutes a branch of clinical psychology which requires specialized training and clinical experience. Given the degree of specialization required, it is unlikely that each institution would have staff psychologists on site who could provide neuropsychological evaluation and consultation. It is suggested that these evaluations be performed by community psychologists on a contractual basis, as needed, if institutional psychologists do not have sufficient background to ensure a delivery of service comparable to a community level.

Neuropsychological evaluations are costly due to lengthy test administration and interpretation. Therefore, issues related to appropriate referral selection have particular importance and the use of screening measurement to assess the need for more in-depth evaluation should be undertaken.

Specific guidelines should be established to identify individuals for referral. In general, it is suggested that neuropsychological evaluations be conducted when an individual presents with a combination of the following:

• behavioural, social or emotional problems, or difficulties in learning;
• a history of head injury, learning disability or specific substance abuse pattern. Substance abuse difficulties with a neuropsychological implication typically involve heavy and prolonged consumption of alcohol, "hard" drugs, and/or inhalant abuse; and
• the individual's ability to profit from institutional programming is in question, or behavioural management problems have been identified.

Typically, these problems will emerge within an institution. For instance, an individual may show an inability to understand or comprehend new information, impaired social interaction, behavioural outbursts, poor memory, impaired concentration, difficulties with orientation, or a failure to learn adequately in academic or vocational settings.

Referrals made primarily to provide information related to the presence of brain impairment, in the absence of an identified and apparent behavioural or learning consequence, should be discouraged. Inmates should not be referred or assessed if they are functioning satisfactorily, despite the potential presence of cognitive limitations.

Current trends in neuropsychology are moving away from the rote administration of test batteries. Instead, a flexible approach in which test selection is more directly based upon the referral concern is more time efficient, and focuses the assessment on the identified areas of concern.

Given the needs of neuropsychological evaluation in a correctional setting, assessments should adopt a "functional," as opposed to "structural," approach. In this sense, the goal of the assessment process should be to identify cognitive processing strengths and weaknesses and indicate the functional consequences for programming purposes.

A more structural approach, in contrast, focuses on identifying and localizing brain lesions, and on formal diagnoses. These have limited impact upon correctional programming, and thus should be of secondary concern.

Initially, information should be gathered from collateral sources such as case management, school or workplace supervisors, and unit staff to ascertain an understanding of the individual's behaviour on a day-to-day basis. Prior to extensive and formal testing, a brief screening process may be suitable to determine whether more in depth evaluation is warranted. For this purpose, the following tests are generally suitable:

• Wechsler Adult Intelligence Test — Revised Edition: A pattern in which large verbal-performance discrepancies (particularly when the performance scales are lower than verbal scales) or the presence of a high degree of intersubtest scatter may be indicative of brain dysfunction.
• Wechsler Memory Scale-Revised Edition: A pattern in which the overall memory quotient score being below normal or significant intersubtest scatter may be indicative of a deficit.
• Trail Making Test: Above average completion times, a pattern of several errors or normal performance on Trails A and below average performance on Trails B may be indicative of a deficit.
• Bender-Gestalt Test: This can be used as a gross screening test of visual motor coordination and motor control. It is, however, no longer considered a valid screening measure for what was formerly referred to as "organicity."
• Mental Status Examinations: Several abbreviated mental status examination interview formats are available commercially, which screen for gross disturbances in functioning in areas such as general orientation and immediate recall. Severe impairments should trigger a more in-depth evaluation.

Beyond initial screening, tests should be selected by the clinician which focus specifically on areas of referral concern. Appropriate areas of identification might include factors such as:

• implication of cognitive processing patterns upon educational programming;
• recommendations for modification of behavioural management techniques within the community, or at the institutional level to case management and unit staff which take the offender's cognitive processing strengths and deficits into consideration;
• explanation of particular patterns of social and/or emotional functioning which may be attributable to the individual's neuropsychological profile; and
• suggestions for and/or provision of specific rehabilitative programming designed to reduce the functional impact of the offender's difficulties.

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Heilman, K. & E. Valenstein. (1985). Clinical Neuropsychology. New York: Oxford.

Kolb, B. & I. Whishaw. (1990). Fundamentals of Human Neuropsychology. New York: W.H. Freeman and Co.

Lezak, M. (1983). Neuropsychological Assessment. New York: Oxford.

McCarthy, R. & E. Warrington. (1990). Cognitive Neuropsychology: A Clinical Introduction. New York: Academic Press.

Spreen, O. & E. Strauss. (1991). A Compendium of Neuropsychology Tests: Administration, Norms and Commentary. New York: Oxford.