9 - Intro to deontology, for future clinicians Flashcards
Autism and intelligence - example of Albert
¤ Several studies/associations recommend the use of identity-first language
when referring to autistic individuals, to respect the expressed preferences of
autistic community (ex: Keating et al., 2022)
Albert
¤ Autistic boy in a specialized school
¤ 7.5 years old
¤ Minimally verbal (uses a few isolated words and occasional combination of 2
words)
¤ New interest for letters
Results
¤ WISC-IV: Block Design 10 (could complete matrix reasoning and coding, other
subtests impossible)
¤ Raven’s Matrices (colored): 90th percentile
¤ Perceptual tasks: faster than typical children of his age
Autism diagnosis (DSM-5)
*Persistent deficits in social communication and social interaction
¤ Social-emotional reciprocity
¤ Non-verbal communicative behaviours
¤ Developing and maintaining relationships
*Restricted, repetitive patterns of behaviors, interests or activities
¤ Stereotyped or repetitive movements, use of objects or speech
¤ Insistence on sameness, inflexible routines
¤ Restricted, fixated interests abnormal in focus or intensity
¤ Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of
environment
Autism: a different cognitive development
¤ Cognitive development in autistic children differs from other children in terms
of perception, language and memory.
“[Autistics’] excellent memory … and the precise recollection of
complex patterns and sequences, bespeak good intelligence.” Kanner, 1943
Prevalence of intellectual disability in autism
*Prevalence of autism:
¤ approximately 1% (meta-analysis from Zeidan et al., 2022)
¤ Sex-ratio: 4 males to 1 female
*Prevalence of intellectual disability among autistic children:
¤ 33% (Zeidan et al., 2022)
¤ 21.7% (Khachadourian et al., 2023)
Is this the real prevalence of intellectual
disability within the autistic population?
The case of R.G.:
¤ 13 years old autistic boy
¤ Minimally verbal
-Uses a few words
-Echolalia
¤ Neuropsych evaluation
(see results)
Is R.G. representative?
Is there a variation in measured intellectual level within and across instruments?
WISC-IV cognitive profile: high iq score for perceptual reasoning
*see other results cuz idgi
Is this cognitive profile
representative of the whole
spectrum?
WISC-IV cognitive profile
(autistic vs. asperger)
With vs. Without speech acquisition delay
(see results, idgi)
How do these profiles develop?
What about young preschoolers?
(see results…)
Is this cognitive profile representative of the whole
spectrum?
What about nonverbal children like R.G.?
(see results)
Reasoning in minimally verbal autistic children
¤ Reasoning abilities are intact in some non-verbal or minimally verbal autistic
children
- Good abilities in perception can be observed
- Correlation between performance in reasoning and in perception in autistic
children
¤ Their intellectual potential is underestimated
¤ Particular role of perceptual processing is also seen in minimally verbal autism
spectrum children (Courchesne et al., 2015)
Take-home messages
¤ Assessing intellectual level and profile in autistic children and adults is complex
- Importance of age
- Comprehension of verbal instructions and testing situation
- Strength-informed assessment (using a variety of tools)
¤ Intellectual potential is often underestimated
Intro to ethics and deontology
for future clinicians.. and other humans
-Don’t practice without a license.
-A license is given by a College. The college mandate is to protect the public. The college is there to regulate the members – their training, their role, their limits
-Psychologist is a protected term.
-Psychotherapist is a protected term.
-Psychotherapy is a protected act.
-Unfortunately, a life coaches, or a mental health experts without a license from
OPQ cannot legally practice psychotherapy. See law 21.
http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=5&file=2009C28F.PDF
-What is psychotherapy? It is a treatment. It is a set of interventions, usually based
on a recognized sets of theories and supported by clinical trials.
https://www.ordrepsy.qc.ca/documents/26707/0/Brochure_Psychotherapy_Asking_the_right_questions.pdf/f0f66138-753f-432b-933d-a9ed6b369d8c
-Don’t practice without a license.
Neuropsychological evaluations and diagnosis are protected act.
Example :
An occupational therapist is indeed a registered professional, registered with
the college of occupational therapists.
Can they diagnose a memory impairment post injury? No
Can they perform a neuropsychological evaluation? No
Can they diagnose someone with “Alzheimer’s disease”? No
Can they recommend a neuropsychological evaluation with a memory
specialist? Yes (I think?)
*the answers weren’t written so this is just what I believe?
For all clinicians, the central principle is
CAUSE NO HARM
Cause no harm. The OPQ has a deontological code to help guide your behavior and
your decisions. http://legisquebec.gouv.qc.ca/fr/ShowDoc/cr/C-26,%20r.%20212
Get proper training. All OPQ members need formal training (doctorate). That is
between 6 and 11 years of University. A 5 days training is not enough to become a
Psychologist.
You may not realize it, but you need the training. Trust the old folks. The more
you will progress, the more you will see to limit of your (our) knowledge.
Learning never ends. Theoretically, knowledge has no end, and it evolves. All
OPQ members need continuous training and supervision, until they retire.
Get informed consent. Always.
Use the test appropriately and only if you have the proper training.
Don’t use the tests if you don’t have the license to interpret them or if you are not supervised. Ex. The WAIS4.
Don’t “burn” our tests, they take decades to develop and one professional to “burn” it. Ex the TMT.
A test is a tool, not an end.
Interpreting tests is not a simple, mechanical procedure.
Just like Terman, Yerkes and Goddard… It’s your responsibility to understand where the data are coming from, understand the tests and the norms very well before
using it.
Clinical judgment > Data
Online or automatized testing is simply not enough.
What did you learn from the article from Courchesne et (2015) “Autistic children at risk of being underestimated: school-based pilot study of a strength-informed
assessment”
Mental Health Diagnosis
Not without a license (MD or Psychologist)
Using the DSM-5
Based on sufficient and competent evaluation of the client.
If you discuss a diagnosis : what is your goal?
Hint : your job usually involves reducing psychological distress.
Be mindfull of self-fulfilling prophecy and labels – are you really helping? Read
page 54
Be clear and understandable, adjust your language and vocabulary – especially
neuropsychologists
DO NOT share raw OR uninterpreted data.
If it means nothing to the client, it may not be that useful
Observe, note, reflect on the client’s reaction, it gives you more information
towards your work
At the end, you communicate your recommendations.
Can you prescribe medication?
No. Psychologist do not prescribe medication.
But you can recommend them to get in touch with their physician.
And you can “discuss” medication with the referring physician, if they are
open – while staying within the limits of your knowledge (ex. some
medication have an impact on memory or language), your work and
observations (ex. you notice the client is primarily anxious and doesn’t
sleep).
You can support the patient but you don’t go AMA.
Where to get the proper information ?
American Psychological Association (APA) - div.40 = NP
Canadian Psychological Association (CPA)
Ordre des Psychologues (OPQ)
Scientific Articles and Publications
Code des professions
Code des psychologues
CAN Government Website
QC Government Website
My 2 cent : keep informed and stay on your toes, subscribe to
your provincial association, go to meetings, supervise students,
get a teaching gig, call your college when you have ethical
dilemmas, etc..
