This blog is now located at http://peripheralbrain2.blogspot.com/.
You will be automatically redirected in 30 seconds, or you may click here.

For feed subscribers, please update your feed subscriptions to
http://peripheralbrain2.blogspot.com/feeds/posts/default.

People keep asking me about autism and deafness. I don't consider this to be an area of expertise for me, but here are the few common responses I give:

Many children are deaf from an interesting biological cause, and that cause can give rise to a whole panoply of interesting psychological sequelae like dyspraxia, semantic pragmatic language disorder, learning disability, low emotional literacy, hyperactivity, attentional problems, etc, all of which mean making a pure diagnosis of autism rather interesting. For these kids the correct “diagnosis” is “a whole bunch of unhelpful neurological problems” and the question then is “do any of this individual’s array of difficulties overlap with the list of symptoms of ASD in such a way that ASD treatment approaches would be helpful?”

There’s more to it than this of course. As well as these aetiological considerations, there are considerations of the consequences of the deafness, such as, do the child’s parents share a language with that child? As a result of the deafness and, probably, hearing parents, is attachment compromised during important early years? Is the child literally deaf to the incidentally learned social mores that define social competence? These cloud the symptom picture even further.

Click here for a PDF factsheet from Sign and the Mental Health Foundation.

Click here to download the paper.

I was asked for my thoughts on intellectual assessment. Here they are:

Primarily, intellectual assessment is not as uninvasive as people imagine. I think there is an assumption that if it doesn't literally get under your skin then it can't be bad. However, physical trauma is self-healing whereas a psychological impact is not. It is not just the case that a below average result would be hard to cope with either; people find it hard to discover that they are "average" as well - and those discovering their IQs are in the 'superior' range can begin questioning their own perceived social standing, successes or failures in the light of this apparent observation of one's ability, leading to doubt and depression. So the first thought is that intellectual testing is not just something that can be done without thought for how the person would cope. Whatever the result might be.

Secondly, 95% of referrals to me are wholly inappropriate, and I imagine that is representative of intellectual function referrals to other psychologists in other services as well. These ill-informed referrals fall into three categories:

1) Those wishing to estimate someone's function in a particular area from an estimate of global intellectual function (ie IQ.) For example, "we think X is unable to manage her money and an IQ value would help us decide that" - No it wouldn't. Test her financial acumen. "We want to know if Y is able to validly consent to sexual relationships and an IQ value would help us decide that" - No it wouldn't. Conduct an assessment of sexual knowledge, assertiveness, and social skills. IQ rarely if ever correlates with these or similar specific concerns, and even if they did at a sample level, that is not to say that it is a valid estimate of THIS person's ability in THIS area. The correct assessment tests the domain in question and does not attempt to extrapolate from IQ data (this is even before we bring into play the question of the validity of hearing tests with deaf people. See elsewhere on this blog for more on that.)

2) Those wishing to diagnose learning disability. To be fair, this is partly fine as IQ forms part of the LD diagnostic criteria. However, it must always be considered alongside a comprehensive assessment of daily living skills. If the living skills are unremarkable, then the IQ is purely academic. Unfortunately people always want IQ first, possibly because it appears to be less time consuming but also because they intend dodging the skills assessment and extrapolating purely from IQ. This is invalid. The question of learning disability is nearly always about how the person manages day-to-day so daily living skills assessments are the bedrock of the assessment. There is one domain in which learning disability is not about function, and that is number three:

3) Learning Disability Teams wishing to know if this or that person meets criteria for their service. For me this is the most inexcusable IQ request there is. Firstly, if a service provider wishes to establish acceptance criteria, then that service is responsible to assessing to see if their customers meet that criteria - nobody else is. Secondly, IQ cutoffs are meaningless and arbitrary as cutoffs for service provision. Nobody, not one person, needs a learning disability team to foster and enhance their intellectual function. What they do often require is support and development of their daily living - so acceptance criteria should reflect that need. I have lost count of the number of times I have been asked to do these assessments. One lady had sensory integration difficulties, physical difficulties, and an IQ of about 120. She clearly needed local LD services to help with housing, support, and DLS - but her IQ forbade it. My position on these things is to firstly say "No." Then sometimes I give in and test anyway because it is worse to leave the person in limbo than to move things forward in an albeit invalid way. When I feel brave enough I sometimes insist the local team do the assessment, knowing that they will invalidly underestimate this deaf person's IQ and so appear to meet their equally invalid criteria. I am happy with the ethics of this, but wary of it because, well, it just feels wrong.

There's probably more than that.