Tuesday, August 23, 2016

Feedback of psychological testing to adult developmentally delayed


Feedback of psychological testing to adult developmentally delayed individuals


Purpose of the assessment:
Feedback: process, purpose, people involved, time taken.
Analysis of the process of feedback:

Adult clients with developmental delay(i.e. mental retardation or subnormal intelligence) or adults who are suspected to have developmental delay are referred for assessment to psychologists and psychometrists( I will call them assessors in this article) at my organization in a major city of  Canada. The reasons for the referral for assessment are :

·        After the client is assessed and found to be developmentally delayed, he is found eligible for accessing the services of the Developmental Sector of the Canadian province he's living in. He is eligible for receiving a monthly pension i.e. money to support himself.

·        If the client is transitioning out of school and has had no recent cognitive assessment, he is referred for assessment. Identifying his current cognitive strengths and deficits will help to find the right fit for him for employment, future studies and so on.

·        If the developmentally delayed client has difficulties getting along in the society, getting along with his family, an assessment of his current cognitive functions will help the people who interact with him, understand if the cognitive deficits are to some extent the cause of his maladaptive behaviours.


Once the assessment is completed, feedback about the findings of the assessment is given to the client by the assessor who did the assessment.

Feedback is the process of letting the client know, after the assessment is completed, about his current strengths and deficits with regard to cognitive functions which were tested such as intelligence, attention and concentration, memory, thinking, reasoning, language abilities, mathematical abilities, etc. If the client consents, people who are closely involved with the client, are also invited to attend the feedback. The people may be family members who live with him or take care of him or a case manager who is working with him or staff from the group home he lives in.

Feedback is usually done in one single session ranging from 45 minutes to one and half hours. The assessor who did the assessment explains the tests  used to assess the client, explains about his performance and the areas of his strengths and weaknesses. The assessor tells the client to ask for clarification if he did not understand and voice disagreement if any.

There are typically no booster sessions done i.e. the feedback regarding the assessment  is not given more than once.

Subsequently a copy of the assessment report is given to the client and with his signed consent, copies are also given to professionals who may be able to use it to the advantage of the client such as his GP, psychiatrist, neurologist, his school if he is going to enroll in a school.

Diligent care is taken so that the report is not given to people who may use the assessment against his best interests.

In my opinion, the process of feedback appears okay at the superficial level. But I believe that  there are many concerns which necessitate tweaking of the feedback process. I believe that this tweaking should be done in all centers of psychological testing if the problems listed below are discovered.

1.     Giving feedback, the way it is done at present, seems to be ‘going through the motions’ than it making any sense to the client, especially if they have moderate developmental delay or greater. Even those who are the low end of mild do not understand 99% of what is being said to them.

2.     Feedback can be understood by clients with mild developmental delay or higher levels of functioning if

Done slowly,

 Without using jargon,

With repetitions where needed,

 Explaining the cognitive strengths and weaknesses of the client by giving examples of real life situations where the assessed cognitive function is used.

It is meaningless to rattle off the names of the tests used and the functions tested using psychological jargon such as working memory, abstract reasoning, etc. The use of these terms is not understood by the laypeople accompanying the clients for the feedback. And these terms mean almost nothing to the clients as they are developmentally delayed. They may understand the three terms in a rudimentary way i.e. intelligence, memory and attention but they would not understand words such as abstract reasoning, visuospatial ability and so on. Yet,assessors don't take care to avoid these terms or explain what they mean, during the feedback.

3.     Most clients, even those with higher abilities, do not remember after a few days, what they heard in the feedback session.  If they don’t remember, there is no way they could use the information in their life in a meaningful manner.

4.     Some assessors give recommendations while some do not. The recommendations given should be in terms simple enough to be understood and applied by the laypersons reading it. It should be given in simple language, with examples and as many day-to-day, real-life applications as possible.

5.     I believe that someone needs to do the following to make the assessment report more meaningful and useful. 
  •  collect a range of tasks typically done in today’s Toronto homes and offices;
  •   these tasks are divided into categories i.e. those which can be done by those with borderline IQ, mild, moderate and severe IQ
  • the tasks can also be arranged by the different cognitive functions needed to do them
  • the clients be informed the tasks within their capacities based on the assessment.
What I have pointed above is not something new but is something done in the vocational assessment reports. I strongly believe that psychologists who do cognitive assessment for the developmentally delayed adults should take these tips from vocational assessment reports.

6.     If it is possible to consolidate the cognitive strengths and weaknesses, along with the other diagnosis’s symptoms (autism, anxiety, depression, etc) and any behaviours observed in the testing and give a hypothesis about the client’s best functioning and areas where the client will likely have problems.
            7. I believe that booster sessions of feedbacks should be done a few times. It would be ideal if the assessor or someone talks to the client about a week and a month and a few months after the feedback and discover how much information from the feedback has been retained. If at least a little practical information has been retained and he client is acting on it, indicates that the feedbadck has been useful. However if the client has no changes in his behaviour or plans even after feedback, it means that


The reasons why I want the feedback interview to be tweaked are many. I have counseled about 300+ clients over the last 8 years.

My job is counselling adults with DD. DD adults are referred to me for counselling for a range of reasons such as anxiety, depression, anger management, OCD, difficulty getting along with others, etc. 
 I discovered, during the course of doing my job,  that many or a majority of the developmentally delayed adult clients referred to me  did not have insight about their developmental delay or autism.
I realized that counselling would be more effective if I first got them to realize they have DD or ASD and secondly they accept that they have DD or ASD.  Yet,  I am not saying  that all clients with insight  about their DD/ASD benefit more from counseling . I have had cases where the client's insight about his DD makes him more difficult to counsel. For example,  Mr.X who knows he is different from others due to his developmental disability has been angry, frustrated and not benefitting from counseling for a very long time compared to a cheerful happy-go-lucky client who has no idea he’s delayed.

To counsel a person who has no insight that they are delayed is difficult at times. Unless the person  understands  and accepts he is delayed, he will not understand why he cannot do certain things and will continue to strive in the wrong direction. The failure leads to further lowering of self-esteem. I have had several cases with this issue.

Two clients I counselled  believe they are learning disabled and not developmentally disabled.
(1) I have tried to educate client ABC over many sessions about her developmental disability and tried to get her to set more realistic goals for herself. She continues to be in denial and is registering for a writing course to become a writer. There are four other possible pressures contributing to her denial of DD:(a) her parents, (b)her siblings , (c)her boy-friend,(d) her own lack of insight or denial. Her parents constantly urge her to 'do better' so that she can have a job, a house, a car, a career like her older sister and like 'other people'. Her parents and siblings themselves are in denial about her disability despite the psychologist explaining to them about  her cognitive assessment results. The parents are immigrants with the typical immigrant dreams of success for their children. Her boy-friend does not know she is developmentally disabled and he urges her to study well and aspire for a  'better job' with a 'higher' income & become 'successful'  and give up her current  job  i.e. waiting tables at a coffee shop, which is within her capacity. Her boy-friend wants her to get into college and later get a better job which is impossible for her level of intelligence. This person has been 'studying' for the last 4-5 years and getting nowhere. Being from a well-to-do family, she has not faced any financial difficulties due to her choices. The years past which could be used to learn a skill within her capacity or get work experience have been used to attend a college where she's learning nothing. But she is having a good time with her friends there and she's not unhappy. This is one positive aspect of this case.

(2)Client DEF has told me that she is not 'retarded' like others and she is only 'learning disabled'. She has no interest in building a friendship with her peers at a day-program for the DD adults she attends. Instead she tries to befriend 'typical' boys who lose interest in her very quickly. She has spent years chasing after these 'typical' boys or boys who are not diagnosed with developmental disability, boys who are in college or working. She does not get it that they lose interest once they get to know her well and continues in this pursuit. She's resolute in her avoidance of her peers i.e. guys with developmental disability who are with her in her program.

(3)The client GHI is moderately delayed and in her mid 30s. She does not ask  a question to be repeated if she does not understand. Instead she says, " I don't want to talk about it' or 'I am not interested' or some such thing. She also shows anger and annoyance during conversations when she does not understand. The person talking to her gets the impression that she's upset. They never suspect that  she has not understood the conversation and they also don't realize that she will not admit that she's not understood. She covers up her lack of understanding with a show of anger and disinterest.

(4)Some parents of developmentally disabled and autistic (and other disabilities) too are in denial or ignorance about their child's disabilities. This leads to poor choices, lack of judgement and this can lead to negative consequences such as financial losses, delay in getting the right help, etc.
I have seen a parent of a mildly autistic young lady refuse to accept the daughter's autism. The autistic child was put in a school with typical children which made it difficult both for the child and the teachers. She was sent to tutors for extra coaching  in the evenings. When the parent finally accepted that her daughter is different and got the autism diagnosis and relevant help, the daughter was 23 years old. The mother went into depression and had a breakdown after this late diagnosis of her daughter and start of treatment. When denial is let go and acceptance starts, depression is possible but this depression can be treated. But the daughter who would have learnt a lot more if she had gone to a special school for the last 12 years, the time is lost forever.

I have seen another parent of a moderately developmentally disabled daughter refuse to let her daughter work in 'cleaning' jobs as she firmly believed her daughter is capable of doing more than cleaning, such as being a receptionist. Despite detailed explaining of her daughter's cognitive test results which indicated moderate developmental delay, the mother believed her daughter should be doing 'higher' jobs.  Despite explaining the multi-tasking, presence of mind and people skills needed to work as a receptionist, the mother refused to believe that her daughter lacks the capacity for the job. She believed that the receptionist has to answer phones and her daughter could do that.

Denial and or Ignorance about Developmental Disability is the problem in the above mentioned cases. Both clients and their family members could have this denial or ignorance about the disability.

I strongly believe that unless this denial/ignorance is dealt with FIRST,  it is difficult to succeed working with them.  Denial and ignorance about the disability means that they are not planning with full information but are making major decisions with a huge piece of  vital and relevant information missing. Making decisions with missing information is bound to lead to erroneous choices and decisions.

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Monday, August 22, 2016

WHO IS THE REAL ME? ARE THERE MANY REAL MES?

Who is the real me? I am so confused!

In a single day, I am so different at different times, I am different with different people...I am different depending on my mood.
I am different depending on what I expect to happen and what actually happens.  I am confused ...which one of these is the 'REAL' me?
My husband thinks I am short-tempered, forgetful, messy & not a great cook. That's true.
My male friend thinks I have a great sense of humour, I am a great cook and I work hard. That's also true.
Some say I am careless, some say I am careful. Some say I am cheap. Some say I am generous.
 Which one of these many mes is the real me?
My mother thinks I don't know cooking, that I am lazy and generous. All of which is true.
My boss thinks I am hardworking and sincere. My colleague who complained against me says I am rude and disrespectful.
Some people find me slow and sleepy. Some folks say I am quick and dynamic. Both are right. But which one is true?


Some times I think I look cute. Sometimes I think I look old. At four a clock I may think I look old but at 5 I think I look cute. Did I really change so much in an hour...from old to cute? I don't think so. So, what is true...cute or old?

Some people like me. Some people don't.
Why is it so? Do some see the nice me and others see the not-nice me?
Are there two mes...one nice and one not-so-nice?
Am I one me or two me or many many mes?
Oh. I am so confused.

Which is the REAL me? The one whose hair was unwashed on Friday and  looked 'not-so-pretty' and whom the salesman ignored in the shop? Or is the real me, the one who looked smart in a mini-skirt and got the once-over, twice from guys?

Is the REAL me, the one  with schizophrenia sitting in the bedroom, brooding for months?
Or is the REAL me the one on Resperidone;  busy living it up in the city working and  partying?

Is the real me the lady with a post-chemo hairless scalp, whom people avoid or feel pity for?
Or is the real me, the lady with 'normal' hair and whose head does not disturb people?
How come people are disturbed by a lady's  bald scalp  a lot more than her brain-dead head?
Is my hair more important than my brain...to the people around me?
Is my personality and behaviour more related to my hair than my brain?

Is the Real me the one with downy cheeks, faint mustache & thick brows and
the Fake me the one with ruby lips, waxed-rouged cheeks, arched brows and thick lashes?

Is the REAL me, the lucid one with lucid memories and talking to the visiting grandchildren?
Or is the REAL me, the Alzheimer one who cannot recognize her son  and yells at the daughter calling her a thief?

Is the real me, the one who was fearful of her nasty professor?
Or is the real me, the one who stood up to her strict  father?

Is the real me, the one who was kind to dogs and cats?
Or is the real me, who made fun of her younger sister and made her cry?

Is the real me, the one who travelled ticketless from the airport to the bus station?
Or is the real me, the one who picked a wallet from the street and gave it to the guy who dropped it?

Is the real me the medicated one who did a great PowerPoint presentation to much applause?
Or is the real me the un-medicated one who 'fell sick' and avoided making the presentation?

Is the real me the one who gets wolf whistles walking down the street in a blonde wig, high heels and short skirt? Or the one dressed as a  nun, getting angry glares as I run to catch the bus?

Is there a real me, every minute...different from the real me of the previous minute ...like the weather and temperature of a day cloudy, sunny, humid, rain all in one day. 15 degrees, 20 degrees, 25 degrees all in one day. If there is 'no one definite weather for a place, why should there be one definite , predictable me?

Is there really a REAL me?  Is the real me a MOSAIC of different parts? Is the real me, different at different times and ergo, there are several real mes, but all are different?
Is the real me a variable me? An unstable me? A 'not-real' me ?
Am I complex or simply dynamic, rolling with the punches and changing all the time  simply to survive?
Is the real me mercurial? If the real me is mercurial, can I predict what the real me will be like, when say, x happens or the real me meets y?

Is there one me? Or many many many mes?
Is there a mercurial me? Or a mosaic me?
Am I a different me with different people...Different people bring out the different behaviours in me...Am I a box of many mes and each person opens the box and dips in and brings out a different me ....My friends bring out the nicer me...my relatives bring out a harsher me....my cat brings out a loving me.....
Frankly, I don't understand me!



 

Friday, August 12, 2016

Job Interview question "What are your weakensses?"

Recently, I was invited to be on the interview panel for a job similar to mine. I found most of the questions okay except for one i.e. the one which asks the interviewee to talk of their 'weaknesses'. The interviewee whose demeanour and answers I really liked till then, said his weakness was "Perfection. I am very perfectionistic and I stress about it. I am now trying to be more relaxed. I am working on it."

This answer was so damn clich├ęd that I wanted to laugh/puke/got a bit disillusioned about this candidate whom I really liked.

I do realize that the candidate cannot give an' honest' answer to this question and risk not getting selected. For the candidate, getting the job is vital and I sort of agree that he has every right to say and do whatever gets her the job.

So what should be done? I believe that the human resource departments have to work on developing better ways of interviewing and cut this dumb question out of all  interviews in all organizations all over the world.
This question contributes nothing to the interview. If the person lies and speaks of a weakness which is actually a strength couched as a weakness,  he gets the job but do you want a person who lies?  On the other hand if he speaks the truth, say for example he admits he's a bit lazy or sloppy, he will not get selected. Ergo, what's the point of this damn question???
Why have a question on the interview which encourages the interviewee to lie in order to do well on the interview? How  does this question help in selecting the right person for the job? Most people who take interviews, read up on Google about the type of questions to expect and come prepared and this preparation itself airbrushes the truth and the panel which falls for the airbrushing select unsuitable candidates over those who are genuine in the interviews.  I have personally observed many lousy workers who did well in interviews get selected and great workers remain unselected due to their poor interview skills. It makes me feel so helpless & frustrated for these people! My heart especially goes out to those with stammering and those who are not great talkers.(limited ability to express themselves but great at their jobs like some introverts and some people for whom English is a second language)

For that matter, many interview questions encourage candidates to 'airbrush' the truth in order to get the job. Questions like, how do you react to criticism, How do you negotiate with a difficult co-worker/boss? How well do you work under pressure? I don't mind these questions so much as I sort of get it that these should be asked and the interviewer can gauge the candidate with their acumen and people reading skills. But it is the question about 'your weaknesses' which really gets under my skin!

Tuesday, August 9, 2016

CRIME FICTION OF POLAND

I am reading at present, a crime fiction set in Warsaw titled Entanglement by Zygmunt Miloszewski.
I think this is possibly the first crime fiction set in Poland and written by a Polish writer that I am reading. Will update whether I enjoyed the book, when I finish.
This same writer has followed up with other books in this series of which this is the first book.

I finished Entanglement and I cannot say I really enjoyed it...it is too entangled for my limited attention span and limited comprehension abilities!

But I am not giving up yet. I do intend to read more books by this author and Poland based as crime in   communist or post communist countries has always fascinated me. 

Monday, August 8, 2016

What age should psychology/social sciences be studied

A cousin's son studying in an elite school in a far eastern country asked my help to write about rioting and how to avoid riots in his country for an assignment. He asked my help as I have studied psychology and he wanted a psychologist's input for his article. He is just 12!

Reading the matter he was referring too I realized the huge amount of psychology's input needed. I was both disturbed and fascinated by this for reasons. On the one hand I am amazed and excited that he is striving for a project with such a high level of complexity and nuances. On the other hand, I also feel that he is too young to know such things. Also I wonder if he really understands i.e. in all it's depth. If he understands, then would he lose the innocence of childhood?

I explained to him that economic inequality, anger of the poor, sense of being exploited and discriminated would lead to rioting. Then I thought a 12 year old should not know such things. I don't know how he is going to take it. Does he really get it? Does this premature exposure to such subjects have no real effect on him and then, he grows up to be indifferent and untouched? Would he be a better, more sensitive and ethical person just because he knows of such things when he's just 12? It's difficult to say, what trajectory his mind will take with this exposure at age 12.
Also he is a child with certain background...upper-middle class, only son, educated parents who care a lot. Now this project is done by his class and each child would have slightly different backgrounds, different temperaments and so on. So the effect of this project on their mind would be different. We don't know how ALL of these kids will be when they grow up after the impact of this project and maybe many more such projects?

I don't mind if the schools push the envelope for maths and science. If the child is intelligent enough, they can push the envelope as far as they can. But, social sciences need to be exposed to children only after they have reached a certain chronological age, assuming that they have the psychological maturity to handle at the riper chronological age.

People in the east have this attitude that social science is 'easy' and 'sciences' are difficult; that any highschooler can read and understand 'college' books of social sciences. I agree and disagree too with this statement. They may understand the content at a cognitive level. But at the emotional level, are they 'getting it' at high-school age? Do they have the  imagination to imagine certain things for example abject poverty and hunger and it's effects on people? Do they have the ability to put themselves in shoes of people of completely different cultures? I dont think so.

I believe, these days, these elite schools are giving projects which make the children mature prematurely if you know what I mean. Also these kids end up possessing 'knowledge and facts' without developing wisdom & empathy which  'would' have got if they had got the knowledge and facts at the right age.
What do you think?

Sunday, August 7, 2016

Uses of Delusions

Just now when reading one of my favorite series (Murder on the TranSiberian Express by Kaminsky) I was struck by what Rostnikov told Karpo. Rostnokov asks Karpo to read a book of poetry and Karpo declines saying that poetry serves no function other than delusion and fantasy. Rostnikov again asks him to read and says,'...Perhaps you have undervalued the function of delusion and fantasy..."


I have been struggling when counselling a few clients of mine who have  paranoid delusions. Some are on anti psychotics, some on anti-depressants and others are not on any medication. Irrespective of the type of medication or the type of diagnosis, all clients' delusions have remained resistant to treatment. 

After reading this perspective of Rostnikov, I think I should reconsider my clients paranoia from a new perspective. What are the gains my clients have with their delusions? By trying to reduce their delusions through CBT counseling, I am probably taking away something which is useful to them and so they resist the efforts I make in psychotherapy. (Also, I do understand that delusions are often resistant to treatment). 

Client one: The functions of delusion for this client: he or she possibly gains some mental satisfaction, seeing him/herself as a victim who has been abused and bullied by society. His/her delusions, probably makes him/her see him/her-self as a 'good person' and makes him/her see the 'others' as bad. 

Client two: The  paranoid delusions of this client helps him/her to experience and express anger against people he/she has little or no interaction. This client would love to have a relationship with people, have a girl/boyfriend and so on but he/she has not succeeded due to many reasons such as his/her illness, social skill deficits, etc. He/she has this delusion that strangers are making nasty comments about him/her. It is likely that he/she has low selfesteem, loneliness and an unfulfilled need for companionship. His/her delusions of paranoia help him/her believe that others are against him, though he/she has done nothing wrong. Here again, the blame is shifted outside and there is no introspection about one's own issues. 

I believe that even paranoid delusions have their uses. 

An article by Margaret Wente talks about the uses of delusions of optimism in the Globe and Mail (December 3 , 2011) I believe that even paranoid delusions have their uses.  The blame is shifted outside of self and one does not have to look into self for problems to be dealt with.

Thursday, August 4, 2016

BEST BOOK FOR SIGHTSEEING NEW YORK CITY

I have read many books for travelling by different companies such as Michelin Travel book, Fodor's , rough guide and so on.

But I found the best to be this book. I could use it as I walked street by stteet, without a cellphone to help me with directions!

The best book for me was New York National Geographic Traveller 4th edition by Michael S Durham and three others