Integrative Literature Review

Professional Psychology: Research and Practice Examining Cognitive Performance and Psychopathology in Individuals Undergoing Parental Competency Evaluations Christian Terry and Len Lecci Online First Publication, December 23, 2021. http://dx.doi.org/10.1037/pro0000436

CITATION Terry, C., & Lecci, L. (2021, December 23). Examining Cognitive Performance and Psychopathology in Individuals Undergoing Parental Competency Evaluations. Professional Psychology: Research and Practice. Advance online publication. http://dx.doi.org/10.1037/pro0000436

Examining Cognitive Performance and Psychopathology in Individuals Undergoing Parental Competency Evaluations

Christian Terry and Len Lecci Department of Psychology, University of North Carolina Wilmington

In the determination of parental fitness, or competency of an individual to care for a child, psychological assessments are often utilized. Moreover, research suggests that parental competency examinees are distinct from child custody examinees with respect to psychopathology and should be studied as a separate group. To that end, the present study examined the cognitive functioning of 136 parental competency examinees who were undergoing court-ordered evaluations, as well as examined the relationship between cognitive functioning (as assessed by the Wechsler Adult Intelligence Scale-IV [WAIS-IV]) and psychopathology (as assessed by the Minnesota Multiphasic Personality Inventory-2 [MMPI-2]). Overall, the parental compe- tency sample had lower education and lower cognitive functioning (particularly Full Scale Intelligence Quotient [FSIQ] and Working Memory Index [WMI]) than the normative sample. MMPI-2 scores paralleled those of previous findings for parental competency examinees, and MMPI-2 Scales 8, 0, and 7 were significantly related to WAIS-IV performance, with lower cognitive scores associated with greater psychopathology. Implications include recognition of the role that cognitive functioning may play in parents being referred for parental competency evaluations, the interaction of comorbid psychopathology and lower cognitive functioning, as well as informing treatment recommendations for individuals with co-occurring psychopathology and cognitive deficits.

Public Significance Statement Parental competency examinees appear to have significantly lower scores in overall intellectual functioning and working memory on the Wechsler Adult Intelligence Scale-IV (WAIS-IV) relative to normative values, and lower cognitive functioning was found to be associated with higher psychopathology on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) scales related to unusual thoughts/attitudes, social isolation, and anxiety. These findings indicate co-occurring psychopathology and cognitive deficits in those referred for parental competency evaluations and this can inform treatment recommendations.

Keywords: parental competency evaluation, psychopathology, cognition, MMPI-2, WAIS-IV

In evaluating parental fitness, or competency of an individual to care for a child, psychological assessments are often utilized to aid in this determination (Budd, 2001; Conley, 2004). Two formal assess- ments that may be included as part of a parental competency test battery are the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, 2010) and the Wechsler Adult Intelligence Scale-IV (WAIS-IV; Wechsler, 2008). Despite the MMPI-2 and WAIS-IV being among the most commonly administered psycho- logical assessment instruments in the United States (Ball et al., 1994), there has been limited research on their relationship with one

another. Indeed, although it has been shown that psychopathology predicts executive functioning (Snyder et al., 2015), it is unclear whether MMPI-2 scores meaningfully relate to WAIS-IV perfor- mance and how this may manifest specifically for parental compe- tency examinees. Moreover, little is known regarding cognition in individuals referred for parental competency evaluations. The pres- ent study seeks to examine the following three issues in a parental competency sample: (a) levels of cognitive functioning as assessed by the WAIS-IV, (b) psychopathology as assessed by the MMPI-2, and (c) the potential overlap among these constructs. Thus, the

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Christian Terry https://orcid.org/0000-0002-3904-0371 CHRISTIAN TERRY received his MA in psychology from the University of

North Carolina Wilmington (UNCW). He is presently completing his internship at Larned State Hospital in Larned, Kansas to attain his PhD in clinical psychology from UNCW. His areas of professional interest include clinical neuropsychological assessment, psychological assessment, and mindfulness-based interventions. LEN LECCI received his PhD in clinical psychology from Arizona State

University. He is presently a professor of psychology at the University of

North Carolina Wilmington and director of clinical services at MARS Memory-Health Network. His research and clinical work focuses on assess- ment, memory disorders, concussion, health anxiety, and bias. The authors have no known conflicts of interest to disclose. Anonymous data used in this study are available at the following link:

https://osf.io/7j6rx/?view_only=baae7d98065a4c47b996c14d34b1b5b1. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Len

Lecci, Department of Psychology, University of North Carolina Wilmington, P.O. Box 5612, 601 S College Road, Wilmington, NC 28403, United States. Email: [email protected]

Professional Psychology: Research and Practice

© 2021 American Psychological Association ISSN: 0735-7028 https://doi.org/10.1037/pro0000436

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purpose of this investigation is to highlight the value of a broader psychological assessment that includes cognitive testing for parental competency evaluations, as both cognitive difficulties and their comorbidity with psychopathology can otherwise be overlooked (Meyer, 2002).

Parental Competency Evaluations and Intellectual Functioning

The process of evaluating competency of an individual to parent is complex. As McGaw et al. (2010) outline, it is typically the case that parents undergo a competency evaluation secondary to con- cerns related to neglect rather than intentional abuse. The neglect often co-occurs with and/or stems from substance use or other mental health disorders (Resendes & Lecci, 2012), and the latter can include intellectual limitations. Although ranges for Intellectual Quotients (IQ) were previously

used to categorize individuals into mild, moderate, and severe levels of intellectual disabilities using the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), the most recent edition of the DSM removes IQ ranges as a criterion and instead emphasizes the consideration of other aspects of client functioning in relation to their objective cognitive performance to aid in diagnoses (American Psychiatric Association, 2013). Using the new criteria, the severity of an individual’s intellectual disability is determined based on their cognitive performance (Criterion A), evidence that these cognitive deficits are impairing the individuals’ ability to function (Criterion B), and onset of these deficits within the developmental period (Criterion C). Thus, while IQ testing can aid in documenting impaired cognitive performance (Criterion A), identifying that an individual’s intellectual functioning is such that they may be unable to care for a child may also contribute to meeting Criterion B. Of course, this interpretation is made only when comparing multi- ple sources of evidence, as IQ testing alone is insufficient to determine high-risk versus low-risk parents (McGaw et al., 2010). Moreover, given the potential comorbidity of cognitive limitations and psychopathology, it is imperative to elucidate the relation between psychopathology and cognition in parental com- petency examinees. Unpacking this relationship may aid any psychological assessor in considering the intersection of cognition and psychopathology in their patients and making appropriate recommendations for needed interventions and prognosis for change. Originally, it was argued that parental competency and custody

examinees are functionally equivalent (Stredny et al., 2006). How- ever, more recent research has determined that there are fundamental differences at least in regard to psychopathology as measured by the MMPI-2 (Resendes & Lecci, 2012). Specifically, competency ex- aminees relative to child custody examinees tend to exhibit a different pattern of defensiveness (elevated L, but lower K), more inconsistent responding (elevated variable response inconsis- tency [VRIN]; true response inconsistency [TRIN]), more unusual responses (elevated F and Fb), and psychopathology related to social introversion, depressive symptoms, difficulty incorporating and accepting societal standards, and unusual thoughts or attitudes (i.e., elevated MMPI-2 Scales 0, 2, 4, and 8, respectively, with differences reflecting large effect sizes ranging from Cohen’s d values of 1.01–1.21).

According to Resendes and Lecci (2012),

parental competency evaluations typically involve a legal intervention by a government agency in order to protect the child (e.g., allegations of abuse, neglect, etc.), and criminal charges may co-occur. In contrast, child custody evaluations are civil cases that largely involve parental disagreement about legal and/or physical custody, without necessarily involving problems with the basic parenting abilities of either par- ent. (p. 1055)

In the former, the utilization of both cognitive and psychopatho- logical assessment is necessary to answer referral questions, such as those related to neglect that may occur secondary to cognitive limitations (e.g., WAIS-IV) and psychological/substance use dis- orders (e.g., MMPI-2).

Cognitive Functioning and Psychopathology

With respect to the overlap between psychopathology and cog- nitive abilities, poorer cognitive functioning is often a specific symptom of a psychological disorder (e.g., diminished concentra- tion in major depressive disorder [MDD], disorganized speech and behavior in schizophrenia). Further, the literature consistently shows that greater psychopathology is associated with lower exec- utive functioning. For instance, Stordal et al. (2005) determined that those experiencing more depressive or schizophrenia-related symp- toms as measured by the Brief Psychiatric Rating Scale-Expanded (Overall & Gorham, 1962) and the General Psychopathology Subscale of the Positive and Negative Syndrome Scale (Kay et al., 1987) exhibited poorer executive function skills as measured by the Wisconsin Card Sorting Test (Heaton et al., 1991), Stroop Color Word Test (Stroop, 1992), Paced Auditory Serial Addition Test (Gronwall, 1977), Digits Backwards subscale of the WAIS-IV (Wechsler, 2008), and Controlled Oral Word Association Test (Benton et al., 1994). Gass (1991) found that anxiety, as measured by MMPI Scale 7, significantly predicted poorer performance on the Speech Perception Test of the Halstead–Reitan (Broshek & Barth, 2000) above and beyond age and education. In all though, other MMPI clinical scales were generally not associated with cognitive performance in their sample of veterans.

Snyder et al. (2015) performed a comprehensive literature review of studies assessing the relationship between various psychopathol- ogies and executive functioning, including inhibition, attentional shifting, updating, and working memory. They identified that the diagnosis of schizophrenia was the strongest predictor of diminished performance for each of these constructs of executive functioning, and that bipolar and MDD inversely predicted executive function, albeit to a lesser degree. Findings were mixed on the relationship between anxiety and executive functioning (Snyder et al., 2015), and for MDD, the findings corroborate research explicitly focusing on the WAIS-IV (Wechsler, 2008). Finally, the initial validation of the WAIS-IV included investigating the cognitive abilities of “special groups” (Wechsler, 2008), one of which was individuals diagnosed with MDD. Results indicated that those with MDD scored lower than matched controls on the Processing Speed Index (PSI; Cohen’s d = .26), and these findings align with prior research (Gorlyn et al., 2006).

Only one known study has directly assessed WAIS profiles of parental competency examinees (McCartan & Gudjonsson, 2016). Researchers analyzed 144 individuals who were evaluated for

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parental competency in the U.K. (i.e., Child Care Proceedings) and who were administered the WAIS-III. Results indicated that their parental competency sample had Full Scale Intelligence Quotient (FSIQ) scores just over 1 SD (M = 83.64) below the normative sample (M = 100, SD = 15). The study also assessed gender differences in personality and psychopathology as measured by the Millon Clinical Multiaxial Inventory, 3rd Edition (MCMI-III) but did not assess the association between cognition and psychopa- thology. This review turns now to the only known studies to directly evaluate the relationship between psychopathology assessed with the MMPI and cognitive performance as measured by the WAIS. Gass and Gutierrez (2017) sought to compare the MMPI-2 with

the WAIS-IV in male veterans using the content scales of the MMPI-2. Inclusion criteria for the MMPI-2 were that they com- pleted at least 557 of the 567 items, did not respond randomly or display a response bias (i.e., VRIN and TRIN < 80 T), did not exaggerate symptoms (i.e., F < 90 T, Fb < 100 T), and did not respond defensively (i.e., K < 60 T). Because the researchers performed correlation analyses between the WAIS-IV indices and MMPI-2 content scales, they condensed the 15 MMPI-2 content scales into three factors of Internalized Emotional Dysfunction (IED; e.g., low self-esteem, low energy, depression), Externalized Emotional Dysfunction (EED; e.g., antisocial attitudes, aggres- siveness, poor anger control), and Fear (i.e., physical health worries, paranoia, and intense fearfulness). None of the WAIS-IV indices correlated with IED and EED, however the Fear factor was signifi- cantly inversely correlated with Perceptual Reasoning Index (PRI), Verbal Comprehension Index (VCI), and FSIQ. The authors also found that those with T-scores greater than 64 on the MMPI-2 Fear factor scales performed more poorly on the VCI and FSIQ indices relative to those with T-scores below 56. It was noted that the Fear factor correlated most strongly with clinical Scales 8, 7, and 3 (Gass & Gutierrez, 2017). Contrary to Gass and Gutierrez’s (2017) findings, Morasco et al.

(2006) found no significant relationships among WAIS-III indices and MMPI-2 clinical scales in a sample of young adults receiving psychoeducational evaluations. Thus, it appears that there is limited and inconsistent evidence of any association between these two frequently employed measures, and the findings may be specific to the population under investigation.

The Present Study

Although research has established connections between specific disorders and executive function abilities, limited research has assessed whether degree of psychopathology (as opposed to the dichotomous presence/absence of a disorder) may influence cogni- tion more broadly. Further, explorations of the relationship between psychopathology and cognition have been very limited in parental competency samples, and past research examining the association between WAIS and MMPI scores (e.g., Gass & Gutierrez, 2017) may have been limited by employing stringent validity cutoff scores. The latter issue may be especially relevant for parental competency evaluations, as some degree of defensiveness has been documented in such samples (e.g., Resendes & Lecci, 2012). Moreover, average L scale scores for child custody examinees have also been shown to be as high as 60 (Bagby et al., 1999, as cited in Graham, 1990). Given the high comorbidity of psychopathology in those with lower cognitive functioning (Peña-Salazar et al., 2018), it is critical to

examine the interaction of comorbities in psychological examinees, especially given that psychopthology and cognitive difficulties can both individually and in combination undermine functional abilities, including with respect to parenting. Further, the effect of these comorbidites on treatment outcomes should be considered when providing treatment recommendations. Thus, the present study seeks to document the cognitive (WAIS-IV) scores of parental competency examinees, their level of psychopathology as assessed by the MMPI-2, and overlap thereof by making the following predictions:

1. Given that cognitive limitations are sometimes noted among the referral questions from Child Protective Services, average WAIS-IV performance for the competency sample is predicted to be below that of the normative sample across all WAIS-IV indices and subscales. Lower WAIS scores (by approximately 1 SD) would replicate the findings from a similar U.K. sample (McCartan & Gudjonsson, 2016).

2. To evaluate representativeness with respect to psychopa- thology, the present competency sample will be compared to scores obtained in previous parental competency samples (Resendes & Lecci, 2012; Stredny et al., 2006). It is predicted that (a) the present sample will generally align with prior samples and (b) that the present competency sample will be significantly different from Bathurst et al.’s (1997) custody sample across all MMPI-2 validity and clinical scales, reinforcing the argument that competency and cus- tody examinees require separate interpretive considerations with respect to psychopathology.

3. We will explore correlations among WAIS-IV indices and MMPI-2 clinical scale scores. Based on prior findings regarding MDD and diminished PSI performance, it is predicted that greater scores on MMPI-2 clinical Scale 2 will predict poorer performance on the WAIS-IV PSI beyond age and education (Gorlyn et al., 2006). Further, the relationship between MMPI-2 Scale 8 and WAIS-IV performance will be explored, given prior findings indicating a negative relationship between thought disorders (e.g., schizophrenia) and cognitive functioning (Snyder et al., 2015; Stordal et al., 2005).

Method

Participants and Procedure

Participants were 136 individuals aged 19–67 (Mage = 31.93, SD = 8.93) whom the court system required to complete a psycho- logical evaluation to aid in the determination of parental compe- tency. The majority already had their child(ren) removed from the home due to concerns from Child Protective Services that one or more problematic circumstances may be present which limit the individual’s ability to parent. These circumstances included sus- pected domestic violence (41.9%), substance use (56.6%), child neglect (37.5%), physical abuse (14%), sexual abuse (6.6%), psy- chiatric instability (44.9%), and cognitive incompetence (14.7%). (Note: These reflect nonmutually exclusive concerns, as 73% of individuals had more than one listed problem). Participants were predominantly female (70.6%) and Caucasian (53.7%), followed by

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PARENTAL COMPETENCY WAIS-IV AND MMPI-2 SCORES 3

African American (37.5%) and Native American (1.5%). Average education was 11.65 years (SD = 1.89) and ranged from 6 to 16 years. The psychological evaluations were completed by a licensed clinical psychologist over the course of approximately 5 hr, reflecting consecutive evaluations occurring from 2012 to 2019. Data were archivally extracted and analyzed using SPSS Statistics software, and the study was approved by the University of North Carolina Wil- mington’s Institutional Review Board (IRB; #20-0110). Anonymous data used in this study are available at the following link: https://osf .io/7j6rx/?view_only=baae7d98065a4c47b996c14d34b1b5b1

Measures

Wechsler Adult Intelligence Scale-IV

The fourth edition of the WAIS-IV (Wechsler, 2008) is one of the most widely used measures of cognitive performance/intelligence and includes the administration of 10 standard scales which take approximately 1.5–2 hr to complete. These 10 scales load onto four broader indices: VCI, PRI, Working Memory Index (WMI), and PSI. These four indices load onto a primary factor called the FSIQ (Wechsler, 2008).

Minnesota Multiphasic Personality Inventory-2

The second edition of the MMPI (i.e., MMPI-2) is a 567-item measure of personality and psychopathology which takes approxi- mately 1–2 hr to complete (Graham, 1990). It contains embedded validity measures to defensive responding (e.g., K, S, and L scales), possible exaggeration (e.g., F, Fp, FBS scales), or indiscriminate responding (e.g., VRIN, TRIN scales). Additionally, 10 clinical scales are related to a range of psychological tendencies and possible psychopathology (e.g., hypochondriasis, depression, somatization in response to stress, antisocial traits, traditional masculine/feminine roles, paranoia, psychological turmoil, thought disturbances, hypoma- nia, and social introversion). The present study focuses on the validity and primary clinical scales. Typically, a T-score of 65 (1.5 SDs > average) is the clinical cutoff for clinical interpretation (Graham, 1990), but scores below 65 can indicate meaningful variability. Although not presented here, participants also completed semi-

structured clinical and parenting interviews and a mental status exam, and records were available from other providers.

Results

Because the present research focuses on the cognitive functioning of a parental competency sample, and because cognitive functioning is related to educational attainment (Kaufman et al., 2009), it is important to examine the educational background of the present sample relative to the normative sample for the WAIS-IV to rule this out as a confounding variable. To determine whether our sample matched the normative sample in terms of average education, we first aggregated the percentages of those within each age and education group reported in the WAIS-IV technical manual. We then compared these percentages for our sample. Level of education in the present competency sample is much

lower than in the WAIS-IV normative sample. Specifically, 18.5% of the competency sample had less than 9 years of education, compared to only 4.6% of the normative sample. About 14.9% of the competency sample had 9–11 years of education, compared to

8.7% of the normative sample. While most of the competency (65.9%) and normative (60.1%) samples had between 12 and 15 years of education, less than 1% of the competency sample had greater than 15 years of education, compared to 26.6% of the normative sample. A chi-square analysis was conducted among the percentage of individuals in the normative versus competency sample across each educational category and this was significant, χ2 (3, N = 136) = 56.03, p < .001. These differences suggest that the present competency sample has a significantly greater number of individuals with less than 12 years of education than the normative WAIS-IV sample.

Also, 12.5% of the competency sample scored in the extremely low range of cognitive functioning (i.e., FSIQ < 70), whereas approximately 2% of the normative sample had FSIQ scores in this range. The 12.5% extremely low FSIQ percentage aligns with the fact that cognitive concerns were noted in the Child Protective Services referrals for 14.7% of the sample. Given that cognitive concerns are a common issue in competency evaluations (identified in 12.5% of the referred cases), this subset of individuals is a contributing factor to the overall competency sample’s WAIS-IV index scores being lower than the normative sample.

Because educational attainment has consistently been shown to positively predict cognition, we first examined this relationship in our competency sample. A bivariate correlation was performed between total years of education and WAIS-IV indices and revealed significant positive correlations between education and VCI: r(134) = .23, p = .008; PRI: r(134) = .20, p = .018; WMI: r(134) = .32, p < .001; PSI: r(134) = .24, p = .005; and FSIQ: r(134) = .29, p < .001. Considering the significant correlation between education and all WAIS-IV indices, and that the education of the competency sample is markedly lower than that of the normative sample, we controlled for education in later analyses that included WAIS-IV scores as a variable.

Hypothesis 1

To compare the WAIS-IV scores of the competency sample with normative values, single-sample t-tests were conducted. All WAIS-IV index scores and FSIQ were significantly lower in the competency sample compared to the normative sample (i.e., stan- dard score of 100; see Table 1). The lowest index scores were the WMI, M = 88.30, t(135) = −9.30, p < .001, Cohen’s d = −0.80, and FSIQ, M = 87.79, t(135) = −9.65, p < .001, Cohen’s d = −0.83. Across WAIS-IV indices, our competency sample performs between the 21st and 28th percentile on average. Single-sample t-tests were also conducted between subscale scores and normative (i.e., 10) scaled scores. Again, all subscale scores were significantly lower than the normative scores, with the lowest being Arithmetic and Coding (see Table 1). This indicates that the parental compe- tency sample shows consistently lower cognitive functioning rela- tive to normative standards. These findings persisted after controlling for education.1

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1 Single-sample t-tests performed in Hypothesis 1 were also conducted using education-adjusted means obtained from an analysis of covariance (ANCOVA). However, education-adjusted means were minimally different than nonadjusted means (i.e., changes were less than one standard point), and results were minimally different. Thus, these findings are not explicated here.

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Hypothesis 2

MMPI-2 validity and clinical scale scores for the present sample were compared with those from two prior parental competency samples (Resendes & Lecci, 2012; Stredny et al., 2006). The hypothesis that scores would be the same between these samples was largely supported (see Table 2), except that when comparing the present sample to Stredny et al.’s (2006) competency sample, Scale 8 is significantly higher and Scale 7 is marginally higher for the present sample. Thus, while slight elevations are seen on two MMPI-2 scaled scores related to anxiety and unusual thoughts/ attitudes, scores for the present sample are largely the same as those from two previous parental competency samples, suggesting that this is a representative sample with respect to MMPI-2-assessed psychopathology. The second portion of this hypothesis, that the present compe-

tency sample will be significantly different from Bathurst et al.’s (1997) custody sample across all MMPI-2 validity and clinical scale scores, was also supported. Moreover, the observed differences resulted in at least medium and in most cases large effect sizes. This finding reinforces the argument that competency and custody ex- aminees are markedly different (i.e., 12 of 14 comparisons resulted in statistically significant and substantial differences) and thus likely require separate interpretive considerations.

Hypothesis 3

As Gass and Gutierrez (2017) have emphasized, obtaining an accurate analysis of the relationship between psychopathology and cognitive performance may only be done when examinees are as effortful as possible when taking the test. In the case of parental competency evaluations, it is quite typical for examinees to exhibit

full effort on the WAIS-IV while also exhibiting a degree of defensiveness evidenced by elevations on MMPI-2 validity scales L and to a lesser degree K. Therefore, inclusion criteria for Hypoth- esis 3 based on the MMPI-2 are that participants completed at least 557 of the 567 items, did not respond randomly or display a response bias (i.e., VRIN and TRIN < 80), did not exaggerate symptoms (i.e., F < 90, Fb < 100; which would be extremely rare for such court- ordered parental competency evaluations), and did not respond in a highly defensive manner (i.e., L and K < 80). Three participants (2.9%2) were excluded due to VRIN T-scores greater than or equal to 80, 11 (10.7%) for TRIN T-scores greater than or equal to 80, 12 (8.8%) for F T-scores greater than or equal to 90, eight (6.5%) for Fb T-scores greater than or equal to 100, 24 (17.6%) for L T-scores greater than or equal to 80, and one (0.7%) for a K T-score greater than or equal to 80. These exclusions were not mutually exclusive and after applying the above criteria, 92 of the 136 participants were left for the exploratory correlations.

A partial correlation, controlling for education, was conducted (see Table 3). The most prominent finding was that Scale 8 (unusual thoughts/attitudes) was significantly negatively correlated with all WAIS-IV indices, with the strongest correlation occurring with WMI, r(90) = −.40, p < .01. This correlation was explored further via hierarchical regression, entering education into Block 1 and Scale 8 into Block 2 to predict WMI. Assumptions for performing the analysis were met. Scatterplots indicated linearity, no skew or kurtosis was detected on p-p and q-q plots, data were homoscedastic, and no violations of independence were noted (e.g., Durbin– Watson = 1.66). Moreover, multicollinearity was not detected. The regression indicated that both education (7.1%, β = 2.53, p < .01, power = .99) and MMPI-2 Scale 8 (13.6%, β = −.48, p < .001, power = .99) significantly explained 20.7% of the variance in WMI performance, R2 = .207, F(2, 89) = 12.85, p < .001. This indicates that after controlling for premorbid cognitive achievement (education), at least one form of MMPI-2-assessed psychopathology predicts poorer cognitive efficiency (working memory) as assessed by the WAIS-IV.

The second most noteworthy finding was the consistently nega- tive correlations between Scale 0 (social introversion) and all WAIS-IV indices, that is, r(90) = −.30 to −.33, p < .01, except for PSI, r(90) = −.18, p > .05. The final MMPI-2 scale to significantly correlate with a majority of WAIS-IV indices was Scale 7 (psychasthenia), which negatively correlated with PRI, r(90) = −.27, p < .05; WMI, r(90) = −.28, p < .01; and FSIQ, r(90) = −.24, p < .05. The latter two findings indicate that social introversion and anxiety are both associated with decreased cogni- tive performance. Four other modest correlations emerged between MMPI-2 scales and WAIS-IV indices. Specifically, Scale 9 (hypo- manic activation) was negatively correlated with VCI and FSIQ, Scale 1 (hypochondriasis) was negatively correlated with PSI, and Scale 3 (hysteria) was positively correlated with VCI (this was the only significant positive correlation to emerge).

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Table 1 Independent Samples t-Tests Between WAIS-IV Normative and Competency Sample Means

WAIS-IV df Competency sample

M (SD) Independent samples t-test

(Cohen’s d)

VCI 135 90.63 (14.91) −7.33* (−0.63) PRI 135 90.22 (14.95) −7.63* (−0.65) WMI 135 88.30 (14.68) −9.30* (−0.80) PSI 135 90.10 (14.25) −8.10* (−0.69) FSIQ 135 87.79 (14.75) −9.65* (−0.83) BD 135 7.99 (2.96) −7.92* (−0.68) SI 135 8.17 (2.86) −7.48* (−0.64) DS 135 8.18 (2.85) −7.45* (−0.64) MR 135 9.00 (3.24) −3.60* (−0.31) VC 135 8.07 (2.83) −7.97* (−0.68) AR 106 7.10 (2.42) −12.37* (−1.20) SS 131 8.45 (3.23) −5.53* (−0.48) CD 133 7.81 (2.66) −9.52* (−0.82) CO 131 8.83 (3.22) −4.17* (−0.36)

Note. Independent samples t-tests were conducted between normative scores and competency samples’ scores. WAIS-IV = Wechsler Adult Intelligence Scale-IV; df = degrees of freedom; VCI = Verbal Comprehension Index; PRI = Perceptual Reasoning Index; WMI = Working Memory Index; PSI = Processing Speed Index; FSIQ = Full Scale Intelligence Quotient; BD = Block Design; SI = Similarities; DS = Digit Span; MR = Matrix Reasoning; VC = Vocabulary; AR = Arithmetic; SS = Symbol Search; CD = Coding; CO = Comprehension. * p < .01.

2 Percentages of excluded cases were based on the total (i.e., n = 136) sample for F, L, and K but were based on a smaller subset of individuals for VRIN (n = 103), TRIN (n = 103), and Fb (n = 124) due to unavailability of T-scores for the remaining participants as they only completed the first 370 items of the MMPI-2. For these latter three scales, those with missing data were still included in the exploratory correlations as long as F, L, and K were valid.

PARENTAL COMPETENCY WAIS-IV AND MMPI-2 SCORES 5

T h is d o cu m en t is co p y ri g ht ed

b y th e A m er ic an

P sy ch o lo g ic al

A ss o ci at io n o r o n e o f it s al li ed

p u b li sh er s.

T h is ar ti cl e is in te nd ed

so le ly

fo r th e p er so n al

u se

o f th e in di v id u al

u se r an d is n o t to

b e d is se m in at ed

b ro ad ly .

T ab

le 2

C o m p a ri n g th e M M P I- 2 S ca le s fo r C u st o d y a n d C o m p et en cy

S a m p le s

A B

C D

A v er su s B

A v er su s C

A v er su s D

M M P I- 2

C o m p et en cy

sa m p le

M (S D );

(N =

1 36 )

C h il d cu st od y

sa m p le

M (S D );

B at h u rs t et

al ., 1 9 9 7

(N =

5 08 )

C o m p et en cy

sa m p le

M (S D ); R es en d es

& L ec ci , 2 0 1 2

(N =

1 3 6 )

C o m p et en cy

sa m p le

M (S D );

S tr ed n y et

al ., 2 00 6

(N =

1 2 7 )

In d ep en d en t

sa m p le s t- te st

(C oh en ’s

d )

In d ep en d en t

sa m pl es

t- te st

(C o h en ’s

d )

In d ep en d en t

sa m p le s t- te st

(C oh en ’s

d )

L 6 5. 6 5 (1 3 .2 7 )

5 6 .0 1 (1 0 .5 4 )

6 2 .6

(1 4 .1 )

6 4 .3 7 (1 2 .6 4)

8 .9 4*

(. 8 6 )

1 .8 4 (. 2 2 )

.8 1 (. 1 0 )

F 6 0. 6 8 (1 7 .8 2 )

4 4 .6 7 (6 .8 2 )

5 8 .9

(1 6 .0 1 )

5 8 .5 9 (1 9 .1 2)

1 6. 3 0 * (1 .5 7 )

.8 7 (. 1 1 )

.9 3 (. 1 1 )

K 5 2. 9 7 (1 2 .8 0 )

5 8 .6 8 (8 .6 1 )

5 2 .6

(1 1 .0 1 )

5 1 .5 0 (1 2 .2 7)

− 6 .1 3*

(− .5 9 )

.2 6 (. 0 3 )

.9 7 (. 1 2 )

F b

5 7. 3 8 (1 8 .3 0 )

4 4 .1 2 (4 .1 7 )

5 6 .1

(1 5 .0 7 )

5 9 .1 7 (1 7 .9 3)

1 4. 8 6 * (1 .4 9 )

.6 2 (. 0 8 )

− .8 0 (− .1 0 )

1 (H

s) 5 7. 3 4 (1 2 .0 1 )

4 8 .3 9 (7 .1 0 )

5 6 .6

(1 1 .3 )

5 4 .2 5 (1 1 .6 1)

1 1. 0 7 * (1 .0 7 )

.5 2 (. 0 6 )

2 .1 6 (. 2 6 )

2 (D

) 5 7. 7 9 (1 1 .1 0 )

4 6 .6 2 (7 .1 1 )

5 7 .2

(1 1 .5 )

5 5 .8 1 (1 1 .0 8)

1 4. 2 6 * (1 .3 8 )

.4 3 (. 0 5 )

1 .4 7 (. 1 8 )

3 (H

y )

5 3. 7 9 (1 2 .4 2 )

5 2 .3 1 (7 .8 9 )

5 4 .6

(1 1 .5 )

5 2 .7 4 (1 2 .3 2)

1 .7 0 (. 1 6 )

− .5 6 (− .0 7)

.7 0 (. 0 9 )

4 (P d)

6 2. 0 4 (1 1 .5 2 )

5 0 .8 7 (7 .3 5 )

6 3 .3

(1 2 .4 )

6 0 .2 6 (1 2 .8 9)

1 3. 7 7 * (1 .3 3 )

− .8 7 (− .1 1)

1 .2 0 (. 1 5 )

5 (M

f) 5 2. 7 7 (1 0 .3 5 )

5 0 .5 6 (8 .8 3 )

5 2 .8

(1 0 .5 )

5 8 .4 6 (1 6 .0 9)

2 .5 0 (. 2 4 )

− .0 2 (− .0 03 )

− 3 .4 7*

(− .4 2 )

6 (P a)

6 0. 3 0 (1 5 .7 4 )

5 2 .4 4 (8 .9 6 )

5 9 .4

(1 3 .7 )

5 8 .4 6 (1 3 .7 2)

7 .5 8*

(. 7 3 )

.5 0 (. 0 6 )

1 .0 3 (. 1 2 )

7 (P t)

5 5. 3 6 (1 1 .8 5 )

4 7 .1 8 (6 .7 7 )

5 4 .3

(1 1 .2 )

5 0 .9 1 (1 4 .5 7)

1 0. 4 5 * (1 .0 1 )

.7 6 (. 0 9 )

2 .7 6* * (. 3 4 )

8 (S c)

5 9. 4 0 (1 3 .7 9 )

4 6 .8 7 (6 .6 2 )

5 6 .9

(1 1 .9 )

5 4 .6 2 (1 0 .6 6)

1 5. 0 3 * (1 .4 5 )

1 .6 0 (. 1 9 )

3 .2 0*

(. 3 9 )

9 (M

a) 5 5. 5 6 (9 .5 3 )

4 8 .3 5 (7 .5 7 )

5 4 .3

(1 0 .3 )

5 4 .8 7 (1 1 .6 7)

9 .3 1*

(. 9 0 )

1 .0 5 (. 1 3 )

.5 3 (. 0 7 )

0 (S i)

5 1. 1 6 (1 0 .0 3 )

4 2 .6 9 (7 .1 )

5 1 .7

(1 0 .4 )

5 1 .6 8 (9 .4 5 )

1 1. 2 4 * (1 .0 8 )

− .4 4 (− .0 5)

− .4 4 (− .0 5 )

N o te .

A B o n fe rr o n ia lp h a co rr ec ti o n w as

ap p li ed

to th e v al ue

o f .0 5 fo r 1 4 o n e- ta il ed

t- te st s ac ro ss ea ch

o f th e th re e co m p ar is o n s, y ie ld in g a v al ue

o f .0 0 3 5 7. C o lu m n A v al u es

ar e fr o m th e p re se n ts tu d y (F b M

an d S D is ca lc u la te d fr o m 1 2 4 p ar ti ci p an ts fo r co lu m n A ,a n d al l o th er sc al es

ar e fr o m N = 1 36 ). C o lu m n B v al ue s ar e fr o m

B at h u rs t et al ., 1 9 9 7 ,T

ab le 1 .C

o lu m n C v al u es

ar e fr o m R es en d es

& L ec ci ,2 0 1 2 ,

T ab le 1 .C

o lu m n D v al ue s ar e fr o m S tr ed n y et al ., 2 00 6 ,T

ab le 1 .M

M P I- 2 = M in n es o ta M ul ti p h as ic P er so n al it y In v en to ry -2 .W

e co n ta ct ed

S tr ed n y et al ., 2 00 6 re g ar d in g th e A v er su s D S ca le 5 d is cr ep an cy

to v er if y th at

S ca le

5 w as

5 8 .4 6 in

th ei r sa m p le

(a s S ca le

6 al so

w as

5 8 .4 6 ), an d th ey

w er e u na b le

to v er if y.

T h u s, th is d is cr ep an cy

is n ot

fu rt h er

ex p lo re d .

* p <

.0 0 3 .

* * T h e p v al u e ac hi ev ed

fo r th e A

v er su s D

an al y si s o f S ca le

7 w as

p =

.0 0 6 .

6 TERRY AND LECCI

Contrary to the previous literature and our prediction, no corre- lation was found between Scale 2 (depressive symptoms) and PSI. This effect also failed to emerge when dichotomizing MMPI-2 Scale 2 scores into high and low, to be more commensurate with the previous literature (Gass & Gutierrez, 2017). Thus, depressive symptoms and processing speed were unrelated.

Discussion

The rationale for examining the cognitive abilities of those undergoing parental competency evaluations is that limited cogni- tive functioning has been raised as a concern by Child Protective Services. Moreover, when evaluating parental competency more broadly, cognitive functioning is often at the forefront. For example, court cases pertaining to termination of parental rights cite low IQ on behalf of the parent as a barrier to parenting in the majority of cases (Callow et al., 2017). Despite this reliance on intellectual abilities, cognition alone is a poor predictor of parental competency (McGaw et al., 2010). Instead, a combination of low intellectual functioning with co-occurring risk factors (e.g., increased psychopathology) and lack of protective factors (e.g., low social support) is more predictive of child outcome and, hence, parental competency (Feldman et al., 2012). Thus, the present study sought to examine (a) levels of cognitive functioning as assessed by the WAIS-IV, (b) psychopa- thology as assessed by the MMPI-2, and (c) the potential overlap among these constructs, as it presents in parental competency evaluations. As expected, the parental competency sample had lower educa-

tion than the normative WAIS-IV sample and had a greater inci- dence of individuals with extremely low cognitive functioning (i.e., 12.5%) compared to the normative sample (i.e., 2%). Moreover, our sample’s WAIS-IV performance was over half a standard deviation below that of the normative sample. This finding indicates that parental competency examinees score on average in the 21st to 28th percentile of cognition. The fact that our sample’s cognitive perfor- mance aligns with another (i.e., McCartan & Gudjonsson, 2016) parental competency sample’s performance, and that a notable (i.e., 12.5%) portion of this sample exhibited extremely low cognitive

function, suggests that similar rates may exist in other parental competency samples elsewhere. Though prior findings suggest that parental competency assessors are including standardized cog- nitive measures in their test batteries (Conley, 2004), assessment of cognitive functioning is not an explicit recommendation found in parental competency assessment guidelines (American Psychological Association [APA], 2013; Steinhauer, 1983) and therefore these areas of potentially problematic functioning may be overlooked. Such an oversight may lead to attributing problem- atic parenting behaviors (e.g., neglect) to more nefarious explana- tions (i.e., intentional neglect), when in fact the provision of parenting classes and/or supportive services could remedy such behaviors. Notably, when examining our sample, 35% of those with FSIQ scores less than 70 were referred due to concerns of neglect.

Aside from the FSIQ, the WMI was normatively the lowest index and was 0.80 SDs below average. Given that the WMI was strongly associated with MMPI-2 Scales 7, 8, and 0, it is possible that the WMI difficulties tend to manifest in the context of mood and thought disturbances (Snyder et al., 2015; Stordal et al., 2005). Moreover, it is also reasonable to assume that the more problems that a parent has (i.e., difficulties affecting multiple domains, such as cognition and psychopathology) the more likely they will experience dysfunction in general and come to the attention of Child Protective Services (e.g., recall that 14.7% of examinees in our sample were referred for cognitive concerns, and 12.5% scored in the extremely low range of cognitive functioning). Thus, although diminished cogni- tion and psychopathology are each factors that may prompt or contribute to Child Protective Services intervention, they likely have a compounding effect on one another. This effect highlights the importance of considering the interaction of cognition with psychopathology.

The underperformance on WAIS-IV subscales, particularly Arithmetic and Vocabulary, aligns with prior findings indicating that lower education corresponds to underperformance on these WAIS subscales (Shuttleworth-Edwards et al., 2004). In our sample, 34.6% of participants performed more than 1 SD below the norma- tive average on Vocabulary, and 45.8% for Arithmetic. This under- performance suggests that both reading literacy and numerical literacy issues may also be common in parental competency cases. Thus, careful consideration should be made regarding a client’s educational attainment and literacy and the effect that it may have in suppressing cognitive performance, especially in evaluations as consequential as those pertaining to parental competency. Adapta- tions may be necessary when illiteracy is of concern (e.g., reading aloud questionnaires to the examinee instead of having them read for themselves when dealing with surveys, etc.). Moreover, limitations associated with literacy may be more amenable to interventions as compared to cognitive limitations that may be associated with congenital or developmental disorders.

The present sample’s scores on the MMPI-2 were largely similar to those of two prior parental competency samples (Resendes & Lecci, 2012; Stredny et al., 2006) with the exception that, when compared to Stredny et al.’s (2006) competency sample, Scale 8 is significantly higher in the present sample. This difference is likely attributable to the present sample having more individuals with disturbances in thinking than in Stredny et al.’s (2006) sample, particularly given the lack of difference on Scale 8 between the present sample and Resendes and Lecci’s (2012) sample. Significant elevations on Scale 8 (i.e., T > 75) raises the possibility of a

T h is d o cu m en t is co p y ri g ht ed

b y th e A m er ic an

P sy ch o lo g ic al

A ss o ci at io n o r o n e o f it s al li ed

p u b li sh er s.

T h is ar ti cl e is in te nd ed

so le ly

fo r th e p er so n al

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o f th e in di v id u al

u se r an d is n o t to

b e d is se m in at ed

b ro ad ly .

Table 3 Partial Correlation Between WAIS-IV Indices and MMPI-2 Clinical Scale Scores, Controlling for Education

MMPI-2 VCI PRI WMI PSI FSIQ

1 (Hs) −.03 −.06 −.15 −.25* −.12 2 (D) 0.0 −.11 −.06 −.10 −.08 3 (Hy) .25* .16 .08 .09 .18 4 (Pd) .17 .12 .04 .14 .15 5 (Mf) −.05 −.16 −.02 −.01 −.08 6 (Pa) −.07 −.11 −.18 −.16 −.13 7 (Pt) −.15 −.27* −.28** −.11 −.24* 8 (Sc) −.23* −.28** −.40** −.29** −.33** 9 (Ma) −.25* −.12 −.21 −.19 −.21* 0 (Si) −.31** −.31** −.30** −.18 −.33**

Note. WAIS-IV =Wechsler Adult Intelligence Scale-IV;MMPI-2 = Minnesota Multiphasic Personality Inventory-2; VCI = Verbal Comprehension Index; PRI = Perceptual Reasoning Index; WMI = Working Memory Index; PSI = Processing Speed Index; FSIQ = Full Scale Intelligence Quotient. Scales 1–0 correspond to MMPI-2 clinical scale T-scores. * p < .05. ** p < .01.

PARENTAL COMPETENCY WAIS-IV AND MMPI-2 SCORES 7

psychotic disorder (Graham, 1990) or at least disturbances in thinking about oneself or others. Schizophrenia and other psychotic disorders are usually characterized as maintaining a chronic course, high comorbidity with substance use and other psychiatric disorders, and frequently necessitate formal and/or informal assistance with daily living activities (American Psychiatric Association, 2013). The impact of these disorders on daily functioning likely increases the chance of a parent with such a disorder, especially when undiagnosed and/or untreated, to come to the attention of Child Protective Services and thereby may account for the greater inci- dence of Scale 8 elevations in parental competency samples. The replication of Resendes and Lecci’s (2012) findings regarding the substantial difference between parental competency and custody samples further highlights that parental competency examiners should not use parental custody data as a means of comparison, and vice versa. Following the precautions recommended by Gass and Gutierrez

(2017), we excluded participants who exhibited invalid response sets on the MMPI-2 prior to conducting the exploratory correlations in Hypothesis 3. It is noteworthy that upwards of 17% of respon- dents had invalid protocols, though this aligns with a previous competency sample (Resendes & Lecci, 2012). As a follow-up exploratory analysis, we sought to examine whether intellectual functioning (i.e., WAIS-IV FSIQ) is related to MMPI-2 invalidity. Independent samples t-tests were conducted separately between those who were and were not excluded due to L, TRIN, and F invalidity. FSIQ scores were significantly lower for those excluded based on elevated TRIN and F T-scores, with the differences reflecting large effect sizes (Cohen’s d values of 1.3 and 1.1, respectfully). Though nonsignificant, those who were excluded due to elevated L T-scores had lower FSIQ scores (M = 83.67) than those who were not excluded (M = 88.68). Despite causality being unclear, these findings implicate low intellectual functioning as a potential source of MMPI-2 invalidity regarding TRIN, atypical responding (F), and possibly defensiveness (L). Clinicians should therefore be mindful to not assume that an invalid MMPI-2 profile indicates a blatant attempt by the examinee to subvert the assessment. The relationship between Scale 8, 0, and 7 and WAIS-IV indices

has important implications for assessing parental competency ex- aminees. For instance, Scale 8 is consistently negatively correlated with WAIS-IV indices suggesting that diminished cognition may be an accompanying factor for individuals with a greater propensity to experience unusual thinking/attitudes. Importantly, only six parti- cipants scored at a level on Scale 8 which would more strongly suggest the presence of a thought disorder (T-score > 75) and a relatively wide range of T-scores (32–93) was obtained. Thus, the relationship between Scale 8 and WAIS-IV indices was likely not solely (or at all) attributable to individuals with thought disorders. Although we considered cognition to be the dependent variable in

our analyses (e.g., Scale 8 predicted WMI), the directionality of the relationship between psychopathology and cognition is unclear. For example, working memory deficits are a common feature of schizo- phrenia (Eryilmaz et al., 2016), yet whether these deficits are a consequence of or comorbid with schizophrenia is not established. Despite nebulous causality, our findings support previous literature indicating that impaired working memory on the WAIS-IV is seen in individuals with disturbances of thinking, as measured by MMPI-2 Scale 8 (Snyder et al., 2015; Stordal et al., 2005). Our findings even

partially support those of Gass and Gutierrez (2017) regarding the impact of fear-related MMPI-2 content scales (which includes Bizarre Mentation, a scale strongly correlated with clinical Scale 8) on the WAIS-IV PRI, VCI, and FSIQ. However, the fact that their Fear factor did not correlate with WMI is less consistent with present findings.

The broad negative correlation between social introversion (Scale 0) and all WAIS-IV indices except for PSI is consistent with the fact that diminished social engagement has been found to occur in individuals with significant psychopathology, such as those with schizophrenia spectrum disorders (Green et al., 2018). Further, it may also be the case that those with lower cognitive functioning have lower social support and, thus, are more socially isolated (Graham, 1990). Regardless of causality, the co-occurrence of low cognition and social introversion implicates the need to provide supportive services (e.g., support groups and other tangible inter- personal help) to individuals with lower cognition and elevated psychopathology.

A significant negative relationship also emerged between MMPI-2 Scale 7 and perceptual reasoning, working memory, and FSIQ. As a measure of psychological turmoil and anxiety, it is reasonable that individuals elevated on this scale would exhibit impaired cognitive performance; particularly given consistent find- ings that anxiety can impact performance on tasks of working memory and attention (Dorenkamp & Vik, 2018). Though some additional, small correlations emerged, these findings must be interpreted with caution given the exploratory nature of the analysis, and future studies can better determine whether these relationships are robust.

Finally, the prediction that MMPI-2 Scale 2 would negatively correlate with PSI was not supported despite depressive symptoms commonly predicting low processing speed in the literature (Gorlyn et al., 2006; Snyder et al., 2015; Wechsler, 2008). One explanation that may account for this is in the measurement of depression. While prior studies utilized the diagnosis of MDD as a predictor for PSI, we used a continuous measure of depressive symptoms. It may be the case that no relationship emerged because MMPI-2 Scale 2 linearly measures depressive symptoms, rather than as a clinically significant diagnosis (e.g., does not include a measure of significant impairment in daily functioning). Other factors related to undergo- ing parental competency examinations may have also contributed to the lack of a relationship between Scale 2 and PSI, such as greater effort typically seen in parental competency examinees, whereas amotivation is a common symptom of depression and may manifest more readily in other assessment contexts. The relationship between MMPI-2 Scale 2 and PSI performance should be assessed in more diverse samples to account for sampling bias.

We argue that the above findings underscore the need to consider comorbidities and the interactions thereof that may be present in psychological assessments of parental competency examinees. The present study specifically highlights the cross section between cognition and psychopathology, but there are countless other comorbid factors that examiners must consider, including most notably substance use disorders.

Limitations

Several limitations should be noted. First, our sample was a parental competency sample with a majority of females, and thus our

T h is d o cu m en t is co p y ri g ht ed

b y th e A m er ic an

P sy ch o lo g ic al

A ss o ci at io n o r o n e o f it s al li ed

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8 TERRY AND LECCI

findings regarding cognition and psychopathology have limited generalizability beyond this population. However, the fact that some relationships align with findings in other populations, such as the relationship between Scale 8 and WMI, indicates this may be a robust finding. It should also be noted that the majority of the sample being female is likely due to the greater tendency of females to take a primary role in caring for the child, rather than females being more likely to have compromised parenting. Further, our sample was obtained archivally and, thus, we were unable to collect other information which may have informed these analyses, such as stand-alone validity tests or psychiatric diagnoses. Comparing cognitive performance with both continuous measures of psycho- pathology (e.g., MMPI-2) in addition to discrete diagnoses would provide important insight into the relationship between psychopa- thology and cognition. That is, identifying thresholds at which psychopathology impacts cognition may inform decisions for when and to what extent to provide interventions. Finally, the newest (third) edition of the MMPI has recently been released, and development of the fifth edition of the WAIS is underway. We utilized the MMPI-2 instead of the MMPI-2-Restructured Form or MMPI-3 because the data collection began in 2012, which predated the newer versions. However, the findings of the present study should be replicated with the MMPI-3 and WAIS-V, when avail- able, to determine whether these relationships persist despite revi- sions to the instruments.

Implications and Applications

Evaluations and research of parental competency should be done with adherence to the Ethics Code (American Psychological Association, 2017) and to guidelines laid out for conducting psy- chological evaluations related to child protection (APA, 2013). These guidelines include, but are not limited to, maintaining impar- tiality, practicing with competence, using multiple data-gathering approaches, and basing conclusions on actuarial data. The present study provides additional actuarial data specific to parental compe- tency evaluations when the WAIS-IV and MMPI-2 are used. These data may inform such assessments and facilitate adherence to ethical guidelines. It should also be noted that, although there is a clear rationale for

the use of tests like the WAIS-IV in parental competency evalua- tions, as cognitive limitations can contribute to less than optimal functioning and coping, there are also clear limitations in using such tests, especially for child custody evaluations (e.g., Brodzinsky, 1993). Measures such as the WAIS-IV and MMPI-2 are by them- selves insufficient to inform whether an individual should be considered to have low parental competence (McGaw et al., 2010). Rather, assessors must integrate multiple sources of data (e.g., social support, occupation) and consider the interaction of the examinee’s risk and protective factors when highlighting possible areas of strengths and weaknesses for parental competency examinees (Callow et al., 2017; Feldman et al., 2012). This study represents the first attempt to identify relationships

between psychopathology as measured by the MMPI-2 and cogni- tion as measured by the WAIS-IV for parental competency exam- inees. Additionally, we have made WAIS-IV index and subscale data of parental competency examinees available for the first time, which may aid evaluators in future parental competency assess- ments as a point of comparison. The data may also be used to

determine a client’s intellectual abilities relative to the average parental competency examinee and whether this may predict paren- tal fitness, in conjunction with MMPI-2 performance.

Of clinical relevance is the co-occurrence of diminished cognition in those with psychopathology, which suggests that the effective- ness of interventions for individuals with disturbances in thinking and/or mood is inversely related to cognitive scores. The presence of borderline intellectual functioning in those who may evidence symptoms of a thought disorder does not bar an individual from being able to effectively participate in treatment (Pitschel-Walz et al., 2009). Rather, the provision of interventions to those with greater psychopathology and/or lower intellectual abilities may be most effective when it is conveyed in a concrete and easily under- stood manner, focuses on skills-based techniques (e.g., dialectical behavior therapy), and minimizes interventions requiring high cognitive demand (e.g., cognitive or insight-oriented therapies). Unsurprisingly, decreased functioning has been observed in higher-severity psychotic disorders with comorbid intellectual dys- function compared to those with similar psychotic disorders without intellectual impairment (Bouras et al., 2004). Thus, a good under- standing of cognitive functioning is critical to parental competency assessments to inform prognosis and treatment recommendations.

Importantly, noncompliance or poor treatment outcome may be perceived as a volitional behavior on the part of the patient to not engage in treatment. However, our findings suggest that comorbid conditions may contribute to this noncompliance. For example, a common treatment recommendation for parental competency ex- aminees is to participate in parenting classes. However, if borderline or impaired intellectual functioning is present (and especially if it goes undetected), then the ability of that individual to understand and engage in the course material may be jeopardized. In the very least, lower cognitive functioning can undermine the informational benefit that can be derived from such classes. As such, a recom- mendation for one-on-one parent training, as opposed to a group format, may be more appropriate. Such an understanding may additionally foster a more compassionate approach to treatment on behalf of the individual administering the intervention when they encounter treatment barriers with the patient. In all, clinicians should consider all risk (e.g., cognitive impairment, psychopathology, lack of employment/housing) and protective (e.g., social support, dis- ability/other assistive services) factors in evaluations of parental competency, and treatment recommendations should likewise be guided by such factors.

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Received April 16, 2021 Revision received September 20, 2021

Accepted September 28, 2021 ▪

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PARENTAL COMPETENCY WAIS-IV AND MMPI-2 SCORES 11