3rd Party Observers –To Allow or Not to Allow?Aliyah Snyder

Forensic Neuropsychology

July 28, 2014

In General…• The field of NP is strongly against 3rd party observation

• Can include: • One-way mirrors• Video-monitoring• Audio recording• Training purposes ok

• Due to concerns about validity and security.

“…neuropsychologists do not, and should not, encourage, condone, or engage in secret recording of neuropsychological interviews or testing.”

- NAN position paper, 2009

More About Validity• Tests created under standardized protocols, many of

which include in the manual that only the examiner and the examinee be present.

• Potentially undermines normative data for test interpretation

Social Facilitation Theory• Zajonc (1965) noted that when species-mates are

present performance on easy tasks improves and performance on difficult tasks declines

• Impairments and Improvements in performance are possible

• Example: Skeleton push fail.

Effects of 3rd Party Observation (TPO)• Audio/Video Recorder*

• negative impact on memory test scores

• “Significant Other”• College subjects referred for NP testing for academic

accommodations • Performed significantly worse: attention, verbal fluency, speeded

info processing if 3rd party observer present• Gender or relationship did not influence results• Observer effect independent of personality (MMPI-II)

• More observers, worse impact

Effects of 3rd Party ObservationContd.

• Head Injuries• Limited NP battery, showed deficits on delayed recall of verbal-

paired associates from WMS-III

• Even supervisors have an effect on YOUR memory• Like we didn’t know this.• Memory Assessment Scales in undergraduates• Global and verbal memory scores worse

Magnitude of Impact• Effect sizes:

• Social Facilitation Research = large• Memory measures = medium

• Average size is .75 of a SD, but found as large as 1.5 SDs.• In practical terms, TPO could take an average memory score of 90 (M = 100, SD=

15) to an impaired memory score of 75 or less.• Motor attention/executive = small

• Overall: attention, learning/memory, and delayed recall tasks** most frequently associated with negative impact of TPO (Eastvold, Belanger, & Vanderploeg, 2012).

• General intellectual and academic abilities, executive functions, and motor tasks not affected by TPO

• Why is TPO such a big deal and not other factors that are not necessarily associated with brain function such as anxiety, environmental inconsistencies (lights), etc.?

Ethics• Patient is denied the opportunity to represent their best,

most objective assessment of cognitive functioning• Neuropsychologists ethically required to protect test

materials• Coaching:

• 22% law students and 42% of practicing attorneys thought they should provide as much detailed info about psych assessment as possible to their clients. (Wetter & Corrigan 1995)

• Can raise MMPI-2 scales w/o impacting validity scales with detailed info about test (Rogers, Bagby, & Chakraborty, 1993)

• Allowing TPOs conflicts with APA ethics codes

TPOs and the Legal System• Attorneys (usually plaintiff) often demand a TPO citing the following:

• transparency is needed for such evaluations • Coaching vs. right of attorney for reviewable record of eval• TPO is for the benefit of the client

• Attorneys may ask for the presence of:• Attorney themselves

• in which case they could be called as a witness at trial• Another psychologist• Paralegal• Court stenographer• Videographer

• TPO excluded in federal court for psychiatric, psych, and neuropsych evals • Some jurisdictions (including Florida) allow:

• Attorneys to attend Independent Medical Examinations (IME) or Compulsory Medical Examinations (CME). Unless it can be argued against.

Therefore, the burden of argument against the observer being present falls to the examiner**

Practical Steps for Individual Practitioner• Education• “affidavit explaining the negative effects of TPOs should be

presented to the court along with the relevant articles and position statements”• Statements from NAN and AACN are available for this purpose

(NAN: Axelrod et al., 2000; AACN: Hamsher, Lee, & Baron, 2001; Colorado Neuropsyc Society:

• Florida requires case-specific reasons why TPOs aren’t admitted, so include this in affidavit

• Affidavits from colleagues may be helpful

• If court orders TPO in spite of efforts, a protective order should be obtained.• Practitioner can always choose to withdraw from the case.

Questions• How can we ensure high standards and accountability in

neuropsych testing without allowing observation?

• What would you say to the following statement:• Since NP data are not normed on individuals undergoing forensic

evaluation anyway, TPO should be allowed.

• Should we systematically control for the impact of TPOs on neuropsych results?

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