Valerie Stone         Cognitive & Social Neuroscience

Legal competence, social impairments, & brain disorders

Quite often, the courts are faced with determining whether someone with a brain impairment is competent to manage their own financial affairs. This can happen for younger adults in cases of severe head injury, or for older adults with dementia or stroke. It can also happen for individuals with developmental disorders, such as Down's syndrome or autism spectrum disorders, when they reach the age of majority.

Any of these brain-based disorders can cause difficulties with everyday activities such as planning a series of errands, making sound financial choices, or resisting deceptive or potentially harmful interpersonal interactions (being "scammed"). The courts turn to neuropsychologists for advice on how severely impaired a client may be in his/her ability to make sound, independent judgments; the courts then use this information to make a ruling on the individual's competence. There is a strong ethical tradition in this area of the law that an individual's autonomy ought not to be taken away without significant cause. The system needs to balance the need to respect autonomy with the need to protect individuals who truly may not be able to protect themselves.

There is a significant gap in the tests available to assess constructs relevant to competency: widely-accepted tests of social judgment are largely lacking. It is all well and good to know whether someone can remember a transaction or write out a cheque, but what one really needs to know is whether the person shows good judgment about who the cheque is written to. Standard neuropsychological assessments generally include a wide range of cognitive tests, such as IQ tests, tests of memory and attention, tests of spatial cognition, and executive function tests. These are widely used, well-researched tests with established norms. For elderly people, there are also tests of whether they can carry out instrumental activities of daily living, or whether they know how to interpret a bank statement or fill out a cheque. However, none of these tests get at the issue of social judgement: does the individual have good judgement about people with whom they might enter into a financial transaction, or the social context surrounding a transaction?

I am trying to fill that gap with my research. In collaboration with several colleagues and students, my lab is developing several tests to be used in assessing the social and financial judgment of individuals with brain-based disorders. These are listed below:

Social Vulnerability Scale for Older Adults: This scale measures a person's tendency to be taken in by fraudulent financial proposals, or scams. It was developed with Donna Pinsker, a UQ PhD student, and Dr. Steve Greenspan, emeritus of U of Connecticut. It is an informant-report scale, to be filled out by a spouse, family member, friend, or other carer. We have shown that the scale has a Cronbach's alpha of 0.92, test-retest reliability of 0.87, and significantly differentiates older adults with and without brain disorders. (See our published paper for details. For her PhD thesis research, Donna Pinsker is further validating this in a sample of healthy older adults, and adults with a variety of dementias. So far we have found that in healthy older adults, the tendency to be socially vulnerable decreases with age, i.e., the older you are, the wiser you are. Preliminary results show that people with dementia are much more vulnerable. Donna Pinsker can be reached at d.pinsker@psy.uq.edu.au. To access the test (it is available online), email me at stone@psy.uq.edu.au.

Social Vulnerability & Bullying Scale for Children: This scale measures a child's vulnerability to being taken advantage of by their peers, tricked into getting into trouble, or tricked out of money or valuables. It was developed with Dr. Kate Sofronoff, an autism expert at UQ, and Dr. Steve Greenspan, emeritus of U of Connecticut. Like the version for older adults, this is an informant-report scale, to be filled out by a parent. In pilot research, an honours student, Caroline Gregory, showed that the scale had a Cronbach's alpha of 0.88 in a sample of 31 parents of children with autism spectrum disorders, was correlated with whether or not the child had been bullied, and significantly differentiated children with Asperger's from a small sample of control children. Dr. Sofronoff's PhD student at UQ, Elizabeth Dark, is doing a more extensive validation study with a larger sample. She can be reached at e.dark@psy.uq.edu.au. As the test has not yet been fully validated, it is not yet publicly available.

Global Interpersonal Skills Test: This scale is a global measure of social skill. It was developed with Catherine Hynes, M.A., a UQ PhD student, and Louise Kelso, a UQ honours student, specifically for use with head-injury patients who suffer social deficits post-injury. There is a self-report version, and an other-report version, that can be filled out by a friend, partner, or family member. An initial validation study, done for Louise Kelso's honours degree, showed that the scale had an alpha of 0.87, and was significantly correlated with social anxiety. Self-esteem was correlated with the difference between self-reports of social skill and peer reports of social skill (people with low self-esteem tended to rate themselves lower than their peers). Furthermore, each individual in the study was rated by between 7 and 10 friends, and the ratings of all the friends were highly intercorrelated as well. Thus, peer reports of one's social skill are highly consistent. Catherine Hynes is conducting further validation research for her PhD thesis at UQ, as well as developing a number of other measures of social judgment. She can be reached at chynes@psy.uq.edu.au. As the test has not yet been fully validated, it is not yet publicly available. Anyone interested in participating in a study using the scale should contact Catherine Hynes.

Faux Pas Recognition Test: Unlike the above, this is not a scale, it is a performance measure of how one interprets social situations that are potentially awkward. It assesses theory of mind inferences, empathy, and has control questions for memory and comprehension. It was developed in collaboration with Dr. Simon Baron-Cohen of U. of Cambridge, UK. Numerous studies in our labs and in other labs show that the Faux Pas Test differentiates typically developing children from children with autism spectrum disorders, head injury patients with frontal damage from controls, and patients with frontotemporal dementia from patients with Alzheimer's disease, as well as controls. The test can be downloaded for free here. Instructions for scoring it are in the same file as the test. Papers relevant to the test, including scores of control participants, are available here.

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