A Methodical Approach
To Recognizing
Mental Disorders and
Cognitive Deficits
Presented by:
Lyn McRainey, PhD
Caryll S. Alpert, AFPD
Outline:
• Why look for mental disabilities in each
client?
• What is a mental disability?
– Mental illness
– Intellectual disability/Cognitive Deficit/Mental
Retardation
• How do we find mental disabilities, in 3
steps?
– Early Indicators
– Information Sources
– Assessment
What are YOUR defense team
obligations?
“My job is to help you. . .”
Why look at every client?
• Model Rules Professional Conduct
– 1.4(b), 1.14
• Case law
– Failure to investigate a mental deficiency can be ineffective assistance
• Special role of defense counsel
• Odds are good
“Imprisonment has become the response of
first resort to far too many of the social problems
that burden people.”
Angela Davis
MENTAL LIMITATIONS CAN AFFECT LEGAL STRATEGIES:
Competency
Juvenile transfers
Detention/bond considerations
Validity of waivers, voluntariness and other suppression issues
• Plea negotiations • Trial considerations/negating intent
• Sentencing •
•
•
•
DSM‐V
• DSM
1952
106 mental disorders
• DSM‐II 1968
182 mental disorders
• DSM‐III 1980
265 mental disorders
• DSM‐IV 1994
297 mental disorders
• DSM‐V
315 mental disorders
2013
MENTAL ILLNESS:
1. Maladaptive responses in domain of
emotions
2. May respond to therapy and/or
medication
3. Can come and go throughout a
lifetime
INTELLECTUAL DISABILITY/
COGNITIVE DEFICIT/
MENTAL RETARDATION:
1. Deficits in cognitive and
adaptive domains
2. Not curable
3. Present before age 18. Lasts a
lifetime.
Define the issues:
• Mental illness
• Intellectual/Cognitive disability
• Both?
STEP ONE:
FIND EARLY INDICATORS
For each client, consciously
and deliberately look for
early indicators of mental
disability
“…an obsession with drugs, delusions of power, paranoid tendencies… still, enough of my problems. What can I do for you?”
“This is my ‘depressed stance’”
What are some early indicators
of mental illness?
Some indicators
of mental illness:
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Emotionally charged behavior
History of multiple incarcerations
Unrealistic view of the situation
History of drug or alcohol addiction or abuse
History of suicide attempts
Multiple out of home placements
History of sexual, emotional, or physical abuse
Perseveration – can't move from topic to topic
History of psychotropic medication
What are some early
indicators of intellectual
disabilities/cognitive
deficits/mental
retardation?
Some indicators of
intellectual disabilities/MR:

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Limited vocabulary
Difficulty answering questions
Immature behavior
Saying what he/she thinks you want to hear
Can't describe facts or details
History of special education
History of dropping out of school
Difficulty finding or keeping employment
STEP TWO:
INFORMATION SOURCES
Gather full information about
your client
CHECKLIST FOR INFORMATION
SOURCES:
•
•
•
•
•
•
•
•
Client Interview
Family Interview
School Records
Medical Records
Mental Health Records
Disability Records
Military Records
Other sources?
CLIENT INTERVIEWS

What can you get?
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School history
Medical history
Job history
Family history
Relationship status
How do you talk about sensitive issues?
Listen to what your client says AND how he
says it.
Ask the obvious.
FAMILY INTERVIEWS:

What can you get?
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Information about pregnancy and birth
Family physical and mental health status
Developmental sequences
Teachers’ impressions
Remember, family members may have
issues similar to your client.
Ask for comparisons.
SCHOOL RECORDS
• What can you get?
– Attendance
– Standardized test scores
– Teacher comments
– Discipline records
– Number of moves
SCHOOL RECORDS—
SPECIAL EDUCATION
• What can you get?
– Diagnosis
– Programs
– Annual IEPs
• Yearly grade equivalent
• Behavior
• Strengths and areas of concern
• Parental concerns and involvement
SCHOOL RECORDS–
SPECIAL EDUCATION (con’t)
• 13 federal categories of SPED
• Eight categories require IQ testing:
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–
–
–
–
–
–
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Learning disability
Speech/language impairment
Health impairment (ADHD)
Intellectual disability
Emotional disturbance
Autism
Developmental delay
Traumatic brain injury
37%
22%
11%
7%
6%
6%
6%
>1%
SCHOOL RECORDS–
SPECIAL EDUCATION (con’t)
• Five categories do not require IQ
testing:
– Multiple disabilities
– Visual impairment
– Orthopedic impairment
– Hearing impairment
– Deaf/blind impairment
<1%
<1%
<1%
<1%
<1%
IQ TESTS
Verbal IQ
Nonverbal IQ
Full Scale IQ or
Composite IQ or
General Intellectual Ability (GIA)
VERBAL IQ
What is this called?
NONVERBAL IQ
Three clients with the
same FS IQ of 76:
Ted Verbal IQ – 55
Nonverbal IQ – 99
Adam Verbal IQ – 98
Nonverbal IQ – 56
John
Nonverbal IQ – 75 Verbal IQ – 78
STEP THREE:
ASSESSMENT
Review your findings. If
appropriate, hire a suitable
expert.
“Have a seat Kermit. What I’m about to tell you might come as a big shock…”
“I’ve always been crazy to keep me from going insane.”
Waylon Jennings