Stephen Greenspan

Intellectual disability as a disorder of reasoning and judgement: the gradual move away from intelligence quotient-ceilings.

Purpose of review Adoption of the term intellectual disability (intellectual developmental disorder, IDD) in DSM-5 represents a shift from a disability (test score) emphasis to a disorder (medical/neurobiological) emphasis. Several implications of this shift for definition and diagnosis of intellectual disability (ID) are discussed. Recent findings The intellectual disability (IDD) section of DSM-5 reflects a growing concern about excessive and inappropriate reliance on intelligence quotient (IQ) cut-offs. Clinicians are now encouraged to take into account various sources of test error; rely more on neuropsychological profiles of cognitive impairments; and approach the adaptive functioning of patients with a greater emphasis on cognitive aspects, such as risk-unawareness. Summary A psychometric approach to intellectual disability/IDD, defining it solely in terms of test scores, is inappropriate for psychiatric and medical disorders, which use a disorder rather than a disability model. The intellectual disability/IDD section in DSM-5 is the first prototypical attempt to broaden the category, and approach it in more clinical terms, while still maintaining the meaning of the condition.

Ethnic and Cultural Factors in Identifying Fetal Alcohol Spectrum Disorders

A large percentage of those involved in the criminal justice system are poor and represent ethnic minorities, and many of them were born to mothers who drank during pregnancy. In this article, we review literature pertaining to physical, social, cognitive, and neurological deficits of individuals with Fetal Alcohol Spectrum Disorders (FASD), exploring the possibility that these deficits or their outward expression may be affected by cultural and ethnic influences. For the most part, the evidence suggests that the indicators of FASD are universal across all racial and cultural groups. These indicators are, however, often obscured in individuals from certain backgrounds, due to the salience of what might be termed “cultural overshadowing.” This could be considered a form of unconscious or institutional discrimination, in that it denies criminal defendants from certain cultural backgrounds the opportunity to have courts take into account the possibility that their alleged or proven offenses were affected by serious brain-based impairments in reasoning and judgment. The law allows for consideration of these impairments in both sentencing and mitigation.

Why People with FASD Fall for Manipulative Ploys: Ethical Limits of Interrogators’ Use of Lies

People with FASD are easily manipulated by others, and such social vulnerability is a major reason why they are so likely to get into serious legal and other forms of difficulty. Police interrogations are also manipulative, in that a detective is attempting to use various ploys—including deceptive statements–to persuade someone to do something he is initially reluctant to do, namely admit to having committed a criminal act. In this paper, the authors use an audiotape of an actual interrogation of a young man with FASD who initially strongly denied guilt, to better understand the way interrogative manipulations (including lies) were used to break his will and get him to confess to a crime which he may or may not have committed.

Adaptive Behavior Alcohol Spectrum and Fetal Disorders

Adaptive Behavior is a construct originally invented as a prong for diagnosing Mental Retardation, but it has come to also play a role in diagnosing Fetal Alcohol Spectrum Disorders (FASD). In this paper, we: (a) describe the meaning and measurement of adaptive behavior, including the need for improved measures (b) illustrate clinical and research uses of the construct, in establishing the diagnosis and behavioral profile of people who have FASD and (c) discuss the forensic uses of adaptive behavior for people with FASD in establishing a mitigation case in criminal proceedings, including possible extension of Atkins (death penalty exemption) protection for people with organic impairments who function just as if they have mental retardation in spite of possessing IQ scores in the borderline range.

FASD and the Concept of “Intellectual Disability Equivalence”

The term “Intellectual Disability (ID) equivalence” refers to accommodations that are made by legal and other governmental entities when they provide services, supports or protective arrangements to people who—because of brain impairment—function as if they have ID but fail to qualify for the ID label which is needed for access to many programs because their IQ scores are a few points too high. Fetal Alcohol Spectrum Disorder (FASD) is a logical candidate for such an accommodation as (a) it (like ID) involves brain impairment, (b) people with FASD have adaptive deficits and support needs that are identical to those with ID, and (c) while many people with FASD do qualify as having ID, the majority do not, because full-scale IQ scores are typically too high.

Response to Mathias and Nettelbeck on the Structure of Competence: Need for Theory-Based Methods to Test Theory-Based Questions.

In this paper, we respond to a 1992 study by Mathias and Nettelbeck in which, using exploratory factor analysis, they argued that the structure of intelligence in persons with mental retardation deviates from the model previously proposed by Greenspan. Applying the LISREL method of confirmatory factor analysis to Mathias and Nettelbecks original correlation matrix, we found the Greenspan model (in which social and practical intelligence form separate factors) to be an equally plausible interpretation of their data as the single (Interpersonal Competence) factor found by Mathias and Nettelbeck. The fundings are discussed with respect to (a) the importance of using theory-based methods when addressing theory-based questions and (b) the role of social intelligence in the ongoing controversy over the meaning of mental retardation.

Social Incompetence of FASD Offenders: Risk-Awareness as a Factor in Criminal Culpability

People with Fetal Alcohol Spectrum Disorders (FASD) have a greater incidence of criminal justice contact, most often for petty offenses but sometimes for serious crimes. There is a growing consensus, as reflected in criminal statutes and bar association recommendations that FASD may decrease culpability for guilt and may be a mitigating factor in sentencing. The rationale usually noted is that the brain damage associated with FASD affects judgment, reasoning and self-control. Such a rationale, while undoubtedly true, would be more understandable and convincing if it could be embedded within a theory of social behavior and potentially impaired capacity and incompetence. In this paper, we describe a model of both static and dynamic social comptence and apply it to concrete criminal offenses engaged in by individuals with FASD or related neuro-developmental disorders.