Alexandra Eckersley trial video: Clinical and forensic psychologist testifies
Updated: 1:42 PM EDT Jul 31, 2024
Do you swear to tell the truth, the whole truth and nothing but the truth under the pains and penalties of perjury. I do may take *** seat. Thank you. Good morning, your honor. Do you need any water? Uh Yes, that’d be great. Thank you. Um I’m gonna pour it for you. Not that I don’t trust you, but these uh things are *** little tricky. Thank you spilling incidents before and I have put *** copy of your report um in front of you. It’s turned upside down. You need to reference it for any reason if you could just tell us that you’re doing that. So it’s clear for the record. Sounds good. Uh Can you please state your name and spell your full name for the record? Matilde Pella Prett Ma Thilde. Last name is Pe L Apr *** T Doctor Pell Pratt. Can you briefly describe to the jury where you got your bachelor’s degree? I got my bachelor’s degree at the University of California, San Diego after graduating from the University of California. Um Did you go on to receive *** doctorate degree anywhere I did? Where was that? I obtained *** doctorate in clinical psychology with *** specialty in forensic psychology from William James College in Massachusetts. And during your time, um during your doctoral training, um what if any internships or other training did you receive beyond education in the classroom? I did multiple internships um including at *** federal medical center which is *** federal prison in Massachusetts. At an outpatient substance use treatment facility. I worked for two years at two different state hospitals in Massachusetts. And I also worked at the juvenile court clinic in Boston. And did you end up graduating and obtaining your doctorate degree? I did, uh after you received your doctorate degree, where did you work? And how did your career uh progress from that point? I started working, I did *** postdoc at the juvenile court clinic in Worcester, Massachusetts. Um at the time I also was working, doing special education evaluations at *** local uh school district and I also worked at *** trauma clinic um doing forensic evaluations with Children and parents in Massachusetts as well. And I think you mentioned you worked for *** juvenile court clinic. Where was that? That was in Worcester, Massachusetts? Did you work for, um, any other uh courts or anything like that during your time and, and early on in your career? Yes. So I was in Worcester at the court clinic for about five years and then I transitioned to the juvenile court clinic in Cambridge for five years. Um, yeah, approximately 57 years, I think actually, um and then in 2012, I also started *** private practice where initially I was seeing um people for therapy. Um and I also was doing private forensic evaluations and then eventually I shifted to just forensic evaluations. And you mentioned you worked at the Cambridge Juvenile Court Clinic and you, and you mentioned some other areas of specialty that suggest that um you focused on working with juveniles. Um beyond working with juveniles. Have you focused your career in any other areas? Yes. So uh even at the court clinic, there was *** wide range of evaluations that I did um including um parenting, evaluations, care and protections, competency to stand trial, criminal responsibility. Um And uh I did sort of the similar thing in my private work or my private practice work doing forensic evaluations with juveniles and adults. Um I currently do some evaluations for the Department of Mental Health. I do various types of court-ordered evaluations in New Hampshire and in Massachusetts. And I also sometimes do forensic evaluations for um various other agencies in both states. Can you estimate about how long you’ve worked with Children, juveniles and emerging adults and adults? Um If you include graduate school, which had internships every year, um it’s 20 years uh beyond the, you know, actual practice areas and working directly with people. Have you held any teaching appointments or any other um appointments in that area in education? Uh where was that um for *** few years, I was uh I taught classes in the mental health counseling program at Suffolk University, which is in Boston. And currently I hold *** teaching appointment at Cambridge Health Alliance, which is affiliated with Harvard Medical School. Um and their child and adolescent psychiatry program. You mentioned that um you started your private practice, did you say 2012? And is that still open? You just focus primarily now on the forensic evaluations rather than doing individual therapy? Yes, I do forensic evaluations full time in my private practice now. And how long have you been doing forensic evaluations? Um, if you include graduate school, it’s also 20 years. And when did you start, uh, consulting on uh criminal cases for juveniles, emerging adults and adults? The first time I started working on forensic evaluations in juvenile criminal cases was in 2006 when I was an intern at the Boston Juvenile Court Clinic. And have you ever been qualified as an expert witness before? Yes. Uh What areas have you been qualified in? You don’t have to give us an exhaustive list. Um, but if you could touch on *** few areas that you’ve been qualified in? Ok. Um, it’s been *** pretty wide range including clinical psychology, forensic psychology, child development diagnosis, assessment, treatment, risk assessments, um, parenting capacity, *** *** pretty wide range. Uh And you mentioned we’ve been talking *** lot how you work with adolescents um, have you ever been qualified in the area of adolescent brain science or anything specific to adolescents? Yes, I have. Ok. Um, and you mentioned, uh, that you’ve been qualified as *** forensic psychologist, but would you mind explaining to the jury kind of generally what *** forensic psychologist is? And does *** forensic psychologist is *** psychologist that provides, um, services and typically in the judicial process, um, it’s not exclusive to the judicial process or legal process. Forensic psychologists also work in correctional settings. They sometimes work with the police and there are other areas where you may also provide consultation, but typically it’s anywhere where psychology and the law might intersect. You also talked um that you’ve been qualified and are certified as *** clinical psychologist. What what generally is *** clinical psychologist? So *** clinical psychologist is their licensed by the state. *** clinical psychologist is someone who has training and experience um and has achieved *** doctoral degree um in providing um evaluation, diagnosis and treatment for mental health disorders. Have you ever testified before? I have and you mentioned um *** couple other entities that you’ve done evaluations for when you’re doing evaluations for the school district or the court. Um Is it the school district and the court that hires and retains you? So when I was working at the court clinic for over uh for about 10 years, um actually more than that, it was about 15 years. All of those evaluations were court ordered. So it was *** judge requesting the evaluation. It wasn’t one side or the other. It was specifically ordered by the court um to evaluate *** juvenile or their family. Um And then with school districts, it’s the school district requesting it um with the Department of Mental Health, it’s the department of Mental Health that’s requesting it. So there’s sort of different types of referrals sources that I work for now that we’ve sort of talked about your education, your experience and where you’ve applied your expertise. I want to talk *** little bit about what you rely on in actually forming your opinion. When you’re asked to offer an expert opinion, what types of documents or other information are you using and relying on to get to your opinion. So there’s typically three components to the evaluations that I conduct. Um One is looking at as many records as I can and the types of records that I typically review and then I like to review are discovery. So police reports, um you know, video or audio of any kind of police investigations, things like that. Um Mental health records, prior psychiatric records, any outpatient treatment that the person may have had school records, sometimes social service records, if the person has received services from the department of Children, youth and families, um and any other kind of evaluations that they may have had or medical records, if they have any medical conditions, the third um thing that I, I’m sorry, the second thing I review is contact with collaterals. So I try to talk to family members if available, I try to talk to current providers if they have *** psychiatrist, *** therapist, if it’s *** young person, recent teachers or, or teachers that they may have right now. Um So I try to talk to as many people as I can that might provide me with relevant information. And then the third piece is direct interviews with the person that’s been referred for evaluation. Can you explain *** little bit about how reviewing police reports do you review sometimes body worn camera sometimes if that’s part of the case. Yes. Can you explain to us how reviewing police reports, body worn cameras interviews audio things of that nature. How does that help you informing your opinion, reviewing those records? Gives me real time information um from folks who were there um documenting what happened in the moment or even being able to see what’s happening in the moment if it’s *** video or audio. So I find police reports to be helpful because you know, officers often document, you know, this is kind of how the person was presenting, this is how they were behaving, this is what they were saying and I can glean clinical information from those records. It helps tell me what was going on psychologically or behaviorally for the person at the time. So it’s I find it to be very rich real time information. How does reviewing, you mentioned that you review *** variety of records from physical to mental health and placement records, psychiatric records. How does reviewing those types of records help you in forming your opinion? It provides me with historical information about the person’s mental health functioning. It allows me to try to create *** timeline of the course of this person’s mental health functioning. So you know, how early were they suffering from mental health issues? What was the nature of those mental health issues? How did those change over time? Um What kind of diagnoses did they have? What kind of treatment did they receive? Did it work? Did it not work? What kind of medications were they prescribed? It also provides me similar to the police reports. It provides me with real time observations from clinicians who are treating the person at the time. So I can read clinician notes, psychologist notes, psychiatrist notes that say, you know, this is what the person is presenting the symptoms they’re presenting with today. And that allows me to understand the historical context of where the person’s mental health functioning has been. And I can then compare that to maybe how they’re doing now. So it allows me to really track and and get *** sense of what has been the course of this person’s psychiatric functioning. You mentioned that you also conduct interviews with collaterals and with the individual that you’re evaluating how does conducting these types of interviews also assist you in forming your opinion. Speaking with collaterals allows me to get different perspectives on the person I’m evaluating. So if I talk to parents, I can get childhood history, information about birth history, early functioning, um how they were doing maybe as an adolescent and their perspective on their child’s functioning over time and, and how their, you know, growth and maturation has been. Sometimes I talk to teachers that allows me to gather information about how this person is maybe doing at school or I talk to their current therapist. It it gives me what their clinical impressions are. What are they working on in therapy? What are the interventions that they’re using? Is it working? Is it not working what their diagnostic impressions are, what symptoms they are seeing? And so it it allows me to gather different perspectives to see, you know, is there agreement here, is there disagreement? You know, why would there be disagreement? It’s just *** lot of extra helpful information for me to try to get as 360 degree view of this person as possible. Is this standard in your field? Do other clinical and forensic psychologists review this type of documentation and conduct these types of interviews, informing their opinions? Yes, that that’s the standard as you try to do all of those things. Your honor. I asked the court recognize Dr Pell Pratt as an expert in forensic and clinical psychology. Any objection? No objection. All right. I, I find this witness so qualified doctor Pell Pratt, before we really get started, I, I wanna talk about how you’re paid for your work. Um, how much are you paid when you consult on *** case? Typically my rate, I typically, I charge an hourly rate. Sometimes it’s *** set flat rate depending on the referral source, but typically it’s $275 an hour. And is that your standard rate? Yes. Is that how much you’re being paid per hour? In this case? It is, and is that rate similar to other clinical and forensic psychologists who are doing similar work to you? Yes, it’s on par with colleagues and, and people that I know doing this work, I want to switch gears to what you were asked to do in this, in this case. Um When were you contacted about Ali Eckersley, January 2023 and who contacted you attorneys, Kim Kosick and Jordan Strand? And after Kim and I contacted you, what, what did we ask you to do? In this case, I was asked to perform *** general psychological evaluation of MS Eckersley with *** focus on what was her functioning at the time of this incident. And when you were preparing to offer an opinion on that particular issue, what documents did you review? I reviewed discovery uh including police reports, body worn, uh body camera, um body worn camera footage, um, audio and video in of uh the police interview, I reviewed extensive clinical uh and mental health records. There were over 7400 pages of records that I reviewed that included um records from placements that Miss Eckersley had been in as *** child, psychological evaluations that hadn’t been done of her school records records from intensive in-home services from psychiatric hospitalizations. Um And um I also spoke with her parents and her therapist that she had been recently meeting with at the time that I met with her. You said that you reviewed interviews? Who were those interviews with the interviews with? Do you mean the interviews? You said that you reviewed an interview? I think you said that the police did, who were the police interviewing uh M Eckersley? And did you review any I know you said you reviewed body worn camera. Did you review any other audio in this case, there was also the 911 call that Miss Eckersley made and did you meet at all with lie? Oh, sorry, you call her Miss Eckersley. I call her lie. Is it fair to say we’re talking about the same person? OK. Um How many times did you meet with Allie? I met with her four times and after reviewing all of the rich data in the records, all of the audio video, body worn camera, police reports after these interviews that you did with with Allie and, and the collaterals. Um What was your overall impression of Allie’s mental health history? MS Eggers Le started exhibiting mental health symptoms at *** very early age at two years old. Um and the nature and course of her symptoms over like over the childhood and adolescence. Um the nature of the symptoms that she exhibited were consistent with bipolar disorder, attention deficit hyperactivity disorder. Um There were also symptoms of post traumatic stress disorder and obsessive compulsive disorder that were noted at times. The um course of her symptoms included um emotional dysregulation, difficulty controlling her behavior, extreme vulnerability um to the influence of others. *** lot of concerns around um delayed maturity. So across all of the records pretty consistently, it was noted that she had bipolar disorder. *** DH D significant executive functioning deficits, difficulties with interpersonal functioning. Um and and delayed maturity was one of the most significant things that was noted and the severity and acuity of her mental health issues was so much so that she required multiple psychiatric hospitalizations. Several long term residential placements when she was at home intensive in home services were needed. She needed special education services and even with all of that support, she really struggled on *** day to day basis. Um In my professional experience, her mental health history is one of the most severe and acute um and chronic mental health histories that I have ever seen in *** child. Um that was also noted by other providers who were evaluating and working with her at the time when she was *** child, that it was one of the most severe cases of pediatric bipolar disorder that they had seen. Um and you know, it was, it was *** very complicated um and, and severe and persistent course of mental health issues that she suffered throughout her childhood. And you mentioned specifically that she had this acute and, and is it fair to say complex uh mental health history as *** child? Was that consistent as she became uh an adolescent and emerging adult? Did it remain complex? It did? So when she approached adolescence, the same, she had the same diagnosis, bipolar disorder, attention deficit hyperactivity disorder, PTSD. But then what became more concerning around that time as well was how, how severe her delayed maturity was in terms of being able to keep herself safe, enabled in terms of being able to actually take care of herself on *** day to day basis. They were concerned about her being very easily influenced by others that she was vulnerable, naive that she was really functioning much more like *** child. Um And that it really necessitated long term residential placement for multiple years during adolescence and early and as she became an emerging adult, you mentioned briefly that you looked at physical health records, were you looking at, you know, I’m talking specifically about when she was *** child. Did you look at any physical health records when she was *** child, I did, did she receive any physical health diagnoses that were part, were part of the mental health picture? Yes. She at around 11 months old was diagnosed with precocious puberty. Um and that is she started to develop secondary sex characteristics that typically start to develop when *** child reaches early adolescence. 1213, she started to develop to develop those at 11 months old and um was seen at Boston Children’s Hospital and they started *** course of hormone injections. But how that influenced the mental health piece is that over time. Um It was *** complicating factor in terms of which medications the psychiatrist would prescribe. And there is *** question at times as to whether that medical disorder may have been playing *** part of the bigger picture of her mental health and behavioral difficulties. I want to switch gears to get *** little bit more specific about some of the things that you have been mentioning. And right now, I want to focus primarily on, you had mentioned that lie had been psychiatrically hospitalized. Uh How many times has lie been psychiatrically hospitalized in her life four times. Uh How young was lie? The first, the, the very first time she was psychiatrically hospitalized, she was seven years old and where was she hospitalized? She was hospitalized at the Hunt Center which is part of North Shore Medical Center um in Massachusetts near Salem. And after that psychiatric hospitalization at the Hunt center when she was just seven years old. Um, when was her next psychiatric hospitalization. So she was hospitalized at seven, at the Hunt Center for manic symptoms. And then she was discharged. And *** few weeks later, she was hospitalized again this time for symptoms of depression. She was then discharged, went home and *** year later, she was psychiatrically hospitalized again. Now, at age eight, also at the Hunt Center and then from there, she was discharged to the long term residential program. And we’re gonna talk about those long term residential programs in *** second. Um But when was the final time that Ali was psychiatrically hospitalized? It was January 2023. So was this after this incident? Yes, it was about *** week after this incident. She was psychiatrically hospitalized. And do you know where she was between December 25th and when she went into the psychiatric hospitalization, she was *** Catholic. Yes, you may if you would hold your answer, please. The injection is overall. Um, Doctor Pratt, do you know where Ali was between when this incident occurred on December 25th? And when she went into her psychiatric hospitalization, she was at Catholic Medical Center. And how long was she at the fourth psychiatric hospitalization? About 2.5 weeks. And now I want to shift gears *** little bit to what you were talking about those long term residential placements. And I think maybe some of our jurors know what that is, but maybe some of them don’t. So, could you generally explain, um, to the jury what *** residential placement is? *** residential placement is *** program that is, um, specifically designed for Children and adolescents who are having severe chronic, severe, uh, mental health or behavioral issues. It’s typically, you know, *** building or *** campus or *** house that is locked, it is staff supervised 24 hours *** day. Um There’s *** treatment team that works with the child. Um Typically the Children go to school or the adolescents, um they go to school on that campus and it is meant to be *** highly structured um very closely supervised and monitored um place where they live so that, you know, they eat, they, they have *** room, um they have activities, they do their treatment there and they, they live there for *** long, you know, typically I think I would say that typically most folks stay at residential placements, *** minimum of 5 to 6 months and upwards of *** couple of years. It’s sort of in my experience what has been kind of like the typical range of someone at *** residential program. And you mentioned that *** residential program, it sounds like it’s *** 24 7 situation. Um Do residential placements have other types of programs that uh kids and teenagers and young adults can engage in different than the 24 7 structure? Yes. So sometimes they offer day programming, day treatment programming. So if you maybe get discharged from the program and you go home, you can go back and do some day programming. Some of them also have day uh day school. So the typically the schools on those in those programs are therapeutically informed, they’re highly structured. Um they have *** high staff to student ratio so that, you know, um if *** child is having difficulties in the classroom, there’s enough folks that can respond to that therapeutically. Um So some, some folks who are residents there and then get discharged home, go back um for school during the day, um because they just need that kind of structured setting for um their education for the school setting and is school at *** residential placement or the one of these day programs, the same as *** traditional school. No. How many residential placements did lie live at throughout her life, she had two long term residential placements. So the first one happened, um when it started when she was eight and she stayed there for two years and then she went home, but she stayed at that, she stayed attending at that program’s day school for *** year. And then she went back to the sort of public school still in *** specialized program within that public school setting. And then several years later when she was 15, she went back to that, um, the same residential program which was called the Perkins school and she was there for five years from 15 to just about 20 is being in *** residential placement for five years. Typical. No, that’s the longest I’ve seen someone be in *** residential placement and how did being in it? It sounds like you describe these are highly structured. Is that fair to say, very structured? I mean, there’s, there’s never *** moment when the child or the, you know, when the resident is without *** staff person, either in the room or being monitored because, you know, they, they just need that level of monitoring and supervision to keep them safe. How did being in these highly structured programs for that long of *** time impact alleys social development? Well, you know, when you’re staying in *** long term residential program like that, especially during formative childhood years, although it might be clinically necessary, it also means that you don’t have the opportunity to experience typical childhood and adolescent experiences. You know, they’re not going to *** typical school, they don’t have long term friends, they’re not on *** team, on *** sports team, they’re not having play dates. Um you’re not at home with your family and whoever your parent or your caregiver is, you know, you’re not going out to the movies. So they’re not experiencing typical child and adolescent um experiences that are important for development. You know, those are experiences that you need to develop social skills to develop how to interact with people to develop how to, you know, take care of yourself for *** day, every day, take *** shower, you know, figure out what to put in your backpack, things like that, they’re not having those opportunities. You’re in *** staff supervised highly structured clinical setting where there’s also other kids that are suffering from significant mental health and behavioral issues. So it can be *** challenging and scary environment for kids sometimes. And although you may develop *** close relationship with some of the staff, it’s not the same as being at home with *** parent or *** caregiver or extended family. So they are not um afforded opportunities to develop the skills, the foundational skills for *** successful transition to adulthood. Um but often they have to be there to keep them safe. It’s just it’s clinically necessary. So there’s pros and cons to those programs. So, despite, you know, some of the things that impact social development by being in these highly structured environments, were these placements therapeutically necessary in your opinion, for Ali, they were, I mean, there were so many concerns about her ability to stay safe and take care of herself and it just was really necessary to teach her sort of basic coping skills to, to manage her mental health and behavioral issues. And now we’ve talked that we’ve talked *** little bit about um how Allie grew up. I want to talk, focus *** little bit on. It’s, you said you reviewed psychological evaluation. So I’m curious how old Allie was when she had her first psychological evaluation, the first sort of, well, she was first treated by *** psychiatrist at 2.5. And so she was first evaluated. Then when she was six years old, *** formal um sort of larger psychological evaluation was conducted with psychological testing and review of records and things like that. How many times has lie engaged in psychological evaluations throughout her life. So in addition to the sort of day to day assessment and evaluation of how she’s doing within *** residential program that the team might do or that staff might do in terms of independent, you know, or supplementary psychological evaluations performed by psychologists. She’s had over *** dozen. What has the psychological evaluations and assessments ali has engaged in consistently revealed about her social, emotional mental and, and behavioral health. So, in terms of mental health symptoms, the most consistent things that she was diagnosed with throughout her childhood were bipolar disorder and *** DH D, there were also symptoms of post traumatic stress disorder and some symptoms of obsessive compulsive disorder that were also noted and um consistently it was that she had, you know, severe and acute forms of those diagnoses, uh particularly the bipolar disorder, the valuations revealed significant deficits in her executive functioning skills. Um Chronic problems with emotional dysregulation that she had significant interpersonal difficulties. So just being able to relate to others testing revealed significant deficits, es especially with um social judgment and social skills. So just her ability to sort of engage in *** typical conversation or to read nonverbal cues or to be able to take other people’s perspectives, to know how to respond in *** particular situation. There were notable deficits across time in that area. There were also uh it was sort of consistently documented that she had significant delays in her maturity. So what that means is, although she may have been *** specific age, she was functioning at *** much younger age by years um than you would expect. So, delayed maturity was consistently noted all the way up until she was 20 years old as she reached adolescence concerns around vulnerability that she was naive, easily influenced by others. There were concerns about her potentially being sexually exploited or sexually victimized by people because she just her ability to keep herself safe and know what was safe or unsafe in situations was really poor. So she was basically would could easily be *** victim um or, or could be victimized that was noted as well. And so I wanna break all of those things down *** little bit and I wanna start specifically with the mental health diagnosis if we can. Um how old was lie when she received her first mental health diagnosis? She was 2.5 years old. And what was that diagnosis? It was attention deficit hyperactivity disorder and is that uh, the acronym *** DH D. Yes. Ok. Um, and after she received the diagnosis of *** DH D, um, when she was *** very small child, what was the next diagnosis she received? It was bipolar disorder. And was she still quite young at that point, she was the psychiatrist that she was seeing that treated her starting at 2.5, saw her until she was five. And in those records, it was noted that within about six months to *** year of observing her from 2.5, that bipolar disorder was added and he started prescribing medications to treat both *** DH D and bipolar disorder. I wanna break down what it means to have bipolar disorder. So, um, can you explain what bipolar disorder is? And some of the symptoms, *** person who is experiencing bipolar disorder might exhibit bipolar disorder is ***, it’s *** mood disorder characterized by manic episodes, depressive episodes. Sometimes hypomanic episodes, the way that it presents in adults can be *** little bit different than how it presents in Children and adolescents. So, in adults manic episodes, it’s typically um elevated mood, they’re feeling very positive, they have racing thoughts, they might be very talkative. Their behaviors are *** little out of character from what you know, is sort of their typical personality. There’s usually reduced need for sleep, pressured speech, they’re talking very fast, depressive episodes are sort of kind of the opposite to that. There’s um depressed mood, tearfulness, dysphoria, suicidal ideation, low self esteem. Um And so with an adult, you might see them cycle through those manic episodes and depressive episodes in young Children, how it often presents is behavioral and emotional dysregulation. So, you know, all kids tantrum. Um but I’m talking about extreme emotional dysregulation, tantrums that are lasting for, that are very intense really outside what you would normally expect for, say *** three year old, four year old and they last *** long time and they’re unable to kind of bring themselves back to *** baseline. They can be in behavioral disc control. So they are, you know, impulsive, they may um you know, put themselves in risky situations or do things that might put their life in jeopardy and they just don’t know that. Um, so it’s significant emotional and behavioral dysregulation in Children. And sometimes you see suicidal ideation, sometimes you see suicide attempts. Um So the presentation is *** little bit different between adults and Children, but as Children age and become adolescents and adults, it starts to become *** little bit more clear. Oh, this is *** manic episode or this is *** depressive depressive episode. And I wanna make sure I understood you correctly. And um it sounds like you’re saying that when someone is experiencing their sy symptoms of bipolar disorder, there can be highs and lows. And for the record, I’m kind of moving my hand like ***, like *** wave is that is it fair to characterize it like that? Yes, it can be like that. So the the manic episodes, if you want to think of it as the mood is very elevated, right? So if like if most folks are kind of like this kind of in this amplitude, you know, folks with bipolar disorder, they have very high highs and very low lows. Um So think of it as like *** sort of big peaks and valleys and the frequency with which they kind of move through, those can vary from person to person. Sometimes it’s what we call rapid cycling in which the mood changes sometimes just within the day or from day to day, sometimes it’s week to week. Sometimes folks have *** manic episode for *** couple of weeks and then they have *** prolonged depressive episode for months or sometimes years. Sometimes they have periods where they’re kind of backup baseline, especially if they’re getting treatment. So it can really vary and can that change potentially from, you know, minute to minute, week to week? It, it can, it can and how, and you mentioned that the symptoms of bipolar disorder, they can manifest themselves one way potentially when someone’s *** child and then it can sort of change over time as they grow into adolescence and adulthood. Um How many doctors confirmed this diagnosis of lie of bipolar disorder throughout throughout her life? Um I mean, I I would say at least *** dozen, you know, I mean, there’s psychiatrists and doctors in the residential programs that are, you know, meeting with her, there’s hospital doctors. So it *** lot. And how old, uh, was lie when she was first receiving treatment for bipolar disorder? I think she was around three years old. Three or four years old. How old was lie when she was first prescribed medication to manage her bipolar disorder? So, for bipolar disorder it was also around 3 to 4. And in your opinion, does ali meet the criteria for bipolar disorder? Yes, I want to switch gears *** little bit and talk more specifically about *** DH D. Um You mentioned that those were one of the primary consistent diagnoses that Allie received. Uh I’m sure many of the jurors know what *** DH D is. But can you explain generally what *** DH D is and what symptoms *** person who has *** DH D might experience *** DH D is what we call *** neurodevelopmental disorder. Um And it’s cha characterized by *** pattern of attention deficits and problems with hyperactivity. So, inattention or attention deficits includes difficulty with um concentration with maintaining uh your attention with organization planning, um decision making, kind of uh you know, uh time management. Um that kind of area of things uh hyperactivity has to do with restlessness, um impulse control issues, difficulties in um sort of controlling or conforming your behavior to the demands of *** particular situation. So, you know, one of the sort of classic examples that I have seen is if you have *** child who’s in school, they’re really having *** hard time following what the teacher is saying. Or they forget to turn in their homework or they lose their homework, um, or they are restless, they are getting up from their chair or they’re bolting out of the room. So they’re having *** really hard time kind of maintaining in *** structured setting like that. And how many doctors confirm the diagnosis of *** DH D for Allie throughout her life? Um similar to bipolar disorders. *** lot, at least *** dozen. And I think you mentioned she was diagnosed with *** DH D around 2.5. Is that when she started receiving treatment for it? Yes. The psychiatrist at that time di uh prescribed her with uh Ritalin, which is ***, *** common stimulant used to treat uh *** DH D. And in your opinion, does lie meet the criteria for *** DH D? Yes. When we were talking about the things that were consistently seen in the records and observed by you, you mentioned emotional dysregulation. Um and I think we all can probably guess what that means. But I’m want, can you explain to the jury what emotional dysregulation means from *** clinical perspective? From *** clinical perspective? Emotional dysregulation is when *** person experiences an extreme kind of emotional response to something that is outside, what might be sort of typically expected, right? So like if, if something happens and *** person gets angry and, you know, they’re kind of in an emotional state, that’s fine. Emotional dysregulation is really beyond what is typically expected. So folks with difficulties with emotional dysregulation, they tend to get flooded with emotions, they don’t know what to do with it, they don’t know how to manage it or regulate it. It usually can last for *** prolonged period of time. Sometimes it’s disproportionate to what the situation calls for so that they may be overreacting or, or disproportionately reacting in *** sort of very emotional way. They don’t know how to identify the emotions and they really can’t bring themselves back to kind of ***, *** calm state. So this is really kind of AAA disorder of being able to um m manage and regulate your feelings. Um So it’s really this kind of flooded feeling. There can also be the opposite reaction where *** person just completely shuts down when they’re flooded with affects. So there can be overreactivity and there can be under reactivity as well. What tends to be more overtly observed is overreactive where they’re, you know, just sort of Externalizing and there maybe kind of their behavior is out of control or they’re yelling or shouting or they’re just in, just in complete, you know, tearful, just sobbing. It’s *** really extreme emotional reaction and this emotional dysregulation, this was observed by you and other providers throughout Ali’s life. Yes, that was very consistently documented as *** difficulty for her. You also mentioned another thing that was consistently documented was immaturity and vulnerability. And I think we all know from just our human interaction, what immaturity means? But can you explain from *** clinical perspective what you mean by immaturity and how that immaturity leads to, to vulnerability? So, immaturity sort of from *** clinical perspective is when *** person is really not functioning developmentally in *** way that you would expect for their age. So sometimes that can be emotionally, maybe, you know, kind of that emotional dis regulation. I was just talking about maybe they’re really sensitive or they have big emotions when you would otherwise expect them to be able to kind of manage that. Sometimes it’s behavioral. Um it can be um social as well. So oftentimes folks who are developmentally immature, they um have difficulty with daily living tasks, they don’t know, sometimes it can be as profound as like they don’t know how to shower, they don’t know how to take care of themselves or they have significant deficits in judgment or social um social skills. So they’re really not able to do the tasks that you would expect someone to be able to do for their, what we would call chronological age or like biological age, right? Like if they’re 15 and they’re developmentally mature, maybe they’re acting more like *** 10 year old or an 11 year old. So oftentimes they can present as naive as vulnerable. So when, especially when you get to the sort of adolescence and early adulthood. If someone is very developmentally delayed, maturity wise, there can be *** lot of concerns about them, um being able to keep themselves safe because they’re easily influenced or they’re naive or they’re vulnerable or they’re gullible, um or they can’t make healthy and safe decisions for themselves. And in the records and in your observations was this immaturity and vulnerability documented and present for lie throughout her life and was the idea that she could potentially become vulnerable at any point, realized it was. Um And what happened? So when she was, I think it was around 12 years old and she was home, living at home but was attending um the public school system where she was living, they had placed her in this one program where actually eval psychological evaluators had noted in their previous reports that they were concerned about her going to that program for school because of her risk or, or vulnerability for um being victimized. She ended up at that school and there were several instances where she was sexually assaulted by other boys, um who I think recognized that she was naive and vulnerable and took advantage of that. And she did not realize in communicating with those boys or in going into the bathroom with them that they maybe had not so good intentions. Um And so she was unfortunately, um sexually victimized *** few times at that school when she was about 13 years old. I think I wanna switch gears to one of the last things that you said um was consistently documented for Ali. Um And this is what you said, impaired executive functioning. Um what is impaired executive functioning, executive functioning skills are skills that are um they’re located in the frontal lobe, like right behind your forehead In what we call the prefrontal cortex and executive functioning skills are things like working memory, um planning, they’re involved in planning judgment, things like initiating tasks, being able to organize, being able to manage your time, uh being able to weigh the pros and cons of *** situation to assess potential courses of action and what the the consequences might be. Um They’re often involved in judgment and decision making. So when you have deficits in those skills, which deficits and executive functionings you are are frequently seen in kids with *** DH D. In fact, it’s sort of, they kind of go hand in hand *** lot of the time. Um when you have deficits in those skills and it can vary where you have deficits, but you might have difficulties with memory functioning, with this making healthy safe decisions with um judgment, with insight. So um those are some of the things that you would see in folks who have deficits in executive functioning is the way I think of it sometimes is, you might have *** really smart kid and you’re telling him in the morning, hey, go grab your backpack, grab your shoes and your water bottle and let’s go and they show up at the door and all they have is their water bottle. And you’re like, well, what happened in your backpack and your shoes and like I forgot, but this kid might be getting straight A’s so they just need *** lot of support. So, but that’s an executive functioning skill to be able to follow *** series of instructions or directions. So, um that I think that’s sort of ***, I think an example that folks can sometimes relate to and this impaired executive functioning. Um was that consistently present in the records you reviewed and the doctors that assessed lie and in your assessment of Allie, yes, she had *** lot of testing, psychological testing done to sort of objectively assess that. And that was consistently noted in her records. Um And are all of these things we’ve been talking about consistent with your impressions of Allie’s mental and behavioral and social development? Um Are they consistent with your impressions of Allie’s social, emotional mental and behavioral health? In December 2022? I wanna go back *** little bit um to Ally’s late adolescence um when she was about 18 years old, uh where was lie living after she turned 18, after she technically became what we see as *** quote unquote adult, she was at the Perkins residential program. She had been there since age 15. And when she turned 18, they transitioned her to like *** transitional living program. The goal of that program is to try to prepare you to hopefully later be able to live independently or somewhat independently. Um And so she was transferred to that program within the Perkins system, did lie other than being in this Perkins school transitional living program, did Allie receive any additional supports? Um As she turned 18, she, her mother obtained guardianship over her at the recommendation of the program due to concerns that they had about Ali’s competency to make decisions for herself as an adult. And the the guardianship was granted, when did lie transition out of this Perkins school transitional Living program? And, and where did she go when she transitioned out of that program? She was close to being 20. They transitioned her to uh this program called the Bridge program. It was *** supported living program for young women. Um And the idea there was that MS Eckersley would be able to have supported. So there’s, there’s staff there, it’s not as intense as the residential program, but it is staff supervised. And um you, you know, typically you attend day programming or sometimes you do some vocational training. Some folks may have *** job but she was in *** supported um uh living program. And when Allie was approximately 20 years old and living at the bridge home. What, what at that time was the focus of the doctors and the providers and the supports there for Allie. So when I reviewed the documents for around that time and the evaluations that they ha that they uh conducted, there were multiple areas of concern. Um One, she continued to have suffered from psychiatric symptoms of bipolar disorder and *** DH D. So although there had been some progress, she still had poor coping skills, she still is experiencing mood swings, she still had some emotional dysregulation. She would still have behavioral difficulties, um problems with impulse control and things like that. So the psychiatric symptoms, although they were being treated, the the treatment was some somewhat effective. There were still concerns around that. There were also significant concerns around her delayed maturity and her vulnerability. So, um at that particular time, they described her as being naive. Um I recall in one of the records that, you know, she was described, although an emerging and what we would call an emerging adult at the time that she was actually functioning much more like an early adolescent um that she um sort of lacked common sense intelligence. Um So just kind of knowing how to navigate the world. And there was *** lot of concern about vulnerability and being easily influenced by others that she had poor boundaries in her relationships. They had found um her on the internet talking to older men and that she was really naive to what was being talked about in terms of, you know, trying to meet up with her. Um So there was *** lot of concern about further sexual exploitation or victimization because her judgment was impaired and she like sort of, you know, things that would maybe raise our alarm bells. Her alarm bells weren’t ringing, you know, when she was having these kinds of conversations or interactions. So there was *** lot of concern about her being naive and vulnerable, emotionally fragile and susceptible to the influence of others. How long was Ali at the bridge home? About 3 to 4 months? And um where did Allie go after leaving the bridge home if you know she went to New Hampshire? Um and do you know why she left and went to New Hampshire? The records indicated? And MS Eckersley told me that she met an older man online who told her to come up to New Hampshire to be with him. And she did is that kind of decision consistent with the impulsivity and vulnerability people were concerned about? Yes. And so you said that she came um from the bridge home up here to New Hampshire. Do you know where she was living? My understanding is that she was unhoused. She was homeless for the entire time that she was living in New Hampshire, which was about 4 to 5 years when Ali came to New Hampshire at around 20 years old. Uh was she getting any medical behavioral or psychiatric care? No, she, she went to Riverbend counseling very briefly. But um didn’t, that didn’t continue. So she basically had no mental health or medical treatment. How long did Ali remain untreated after leaving the bridge home when she was 20 years old? Uh What was the whole time, essentially the whole time she was in New Hampshire? So, about four or five years in these years that we’re talking about, you know, sort of the 20 to, to 25 range. I mean, how important are those years for *** young person’s development? And more specifically, how important was that those years to Ali’s development? Well, in general, those are still really important developmental years. Um the brain is still developing maturity is still happening. Um What we typically have understood is adolescence is actually now with *** lot of neuroscientific research is still actually happening in the early twenties. Um So they are important years in terms of, you know, maturing, in terms of learning and acquiring skills to be *** functioning adult in society. Um And so, you know, you sort of need an environment that is conducive to that. But for Miss Eckersley, she was living in *** situation with, you know, chronic stress, she had no home, she had no medical or mental health treatment, she did not have any caregivers or providers sort of supporting her. Um She uh was victimized at various points during that time. So the the environment that she was in was not only not conducive to growth and progress and maturing. Um But it arguably exacerbated her mental health symptoms and potentially further stunted her, her maturity and development and for lack of *** better clinical term. Um Before that point, Allie Allie was already behind developmentally and maturity wise, she was, she was quite behind and this five year period is it fair to say that put her even further back? I I think it’s reasonable to assume that it, it put her back or it at least held her where she was, but I think put her back more. Um Yeah, and you talked *** little bit already about um how being homeless impacted her mental health and development. Um But when Allie was in house during that period, was there anything else that was going on with her that was negatively impacting her overall mental and behavioral health? She was using methamphetamines every day? And was there any evidence in the records you reviewed that? And would you would it be fair to say that using methamphetamine every day? Is that *** substance use disorder? Um Is there any evidence in the records that you reviewed that Ali had *** substance use disorder prior to moving to New Hampshire. So there was no evidence of substance use disorder. She had not, there was nothing in the records that I saw that she had ever used substances, but because of the vulnerability and immaturity. It was documented that there was concern about her potentially developing *** substance use disorder. What impact did chronic drug use have on Allie’s mental health and development? Well, I mean, chronic drug use, especially amphetamine use in general can cause significant uh problems including uh brain damage. Um, it can exacerbate mental health symptoms. Um, there’s also symptoms associated with the process of acquiring drugs and the things that you sometimes you have to do to get drugs and money and stuff like for drugs. Um I think in MS Eckersley’s case, um there, the chronic drug use for her not only think exacerbated her mental health symptoms, but it also, um I think, uh stunted her maturity, um and, you know, impacted her judgment and functioning. I mean, when I, when I was talking to her, when I was interviewing her, she talked about how she had frequent mood swings that she was kind of, you know, sometimes yelling at people shouting at people that she was kind of not in control. Um And so I think that sort of paints the picture that the drug use not only caused sort of its own uh damage, but that it exacerbated her mental health symptoms and stunted her maturity. And so all of these things being homeless, not engaging in medical care and the chronic drug use. Um Generally speaking, how did that impact her development? In my opinion, it stunted her development, you know, we were when I was talking earlier about the environment that’s conducive to growth and progress. Um That was not an environment that I don’t think she may. I think she regressed during that time, there was regression in her behavior and functioning based on your review of the available records, the police reports, the the body worn camera, the interviews, the 911 call, every everything that we’ve been talking about. Um Can you tell us to *** reasonable degree of scientific certainty how Ali was functioning on the night of December 25th, going into December 26th of 2022. So in reviewing all of the records, which was, you know, all of our childhood records as well as um the medical records after the incident and the psychiatric records after the incident, which provided me with rich information about that clinical observations there about her mental health functioning and, and behavior and the regressive behaviors that she was exhibiting. Um It’s my opinion that the night of that day and in the time around it that she was suffering from symptoms of bipolar disorder that she was suffering from symptoms of an amphetamine use disorder that the concerns and and behaviors of developmental immaturity were there. So, you know, deficits in executive functioning problems with judgment and decision making, the emotional dysregulation, all of those things that she had exhibited during childhood and adolescence, I saw glimmers of that. Um and evidence of that I should say in the videos in and also in medical and psychiatric records from providers that were treating her very shortly after this incident. Um There was information about, you know that she had lab, *** Catholic medical center, she had label labile affect, you know, that she was kind of irritable um that she had these regressive behaviors and that was also documented then in the psychiatric hospitalization records and then it also the treatment records, um following that psychiatric hospitalization. And when I talked to her therapist that was treating her, also reported similar symptoms. And when you’re talking about regressive behaviors, what did those behaviors look like specifically for lie if you know, based on your review of all the data and the records and everything we’ve been, you know, talking about, um in the, in the records for *** Catholic medical Center, for example, it was noted that she was voraciously eating, you know, so, you know, the crackers that you get at the hospital, um, she was stuffing those in her mouth. She was hoarding the food, she would sort of growl at providers sometimes if they got near her or near the food, the toilet in her room was overflowing with feces and she was still using it. She was not changing her sanitary pads as you’re supposed to do after you have *** vaginal delivery. Um, and her mood was very labile. Um It, it actually raised it, it got to the point where the staff at Catholic Medical Center were concerned about her competency or inability to make her own medical decisions. And they had her evaluated for that, they did ultimately find her competent to make medical decisions. But the concerns around her behavior and those regressive behaviors remained. And then when I talked to the therapist that she met with some time later, that therapist said that she had to work with Miss Eckersley on learning how to shower, how to use utensils to eat, how to use deodorant. Very basic daily living skills that she had to relearn before they can even launch into, you know, treating the mental health symptoms. Um The PTSD symptoms and things like that in terms of her emotional state was she, you know, average. Was this *** heightened emotional state on the 25th? What, what, what did you glean about her emotional state? Um in reviewing the records and the audio and video, it was from *** clinical perspective. It was clear to me that she was in *** very heightened emotional state. She was distraught, she was tearful at times. Sometimes she was um inter interrupting people who were talking to her, which would, to me that indicates poor impulse control. So, you know, folks with *** DH D sometimes they blurt things out or they interrupt people or they cut people off. That’s *** s that’s an impulse control issue is waiting your turn. So there was evidence of poor impulse control. Um, there was evidence of so sh she was definitely in *** very heightened emotional state. There were, you could tell sort of in the tone of her voice and how she was talking, she was very distraught. It seemed like she was in shock. Um, and it was there, there were notable, um, behaviors and kind of signs for me clinically that indicated that, that these things were going on for her. And was she always in that tearful, heightened emotional state? Or were there times where she was less heightened emotionally? It did, it did vary. There were times where she was, you know, crying, tearful, distraught and then other times where she was *** little bit calmer, there were other times where she was agitated and restless, she was moving around *** lot. She had um like her involuntary movements in her mouth and tongue, um which caused some slurred speech. And so it, it, her, her, what, what I would call affects of her like emotional presentation kind of like that she was demonstrating. It did vary um uh sort of even within like the videos that I watched but was consistent with still being in like this heightened emotional state. It just kind of was up and down and in your opinion was ally functioning like an average 26 year old woman. No. Why do you believe that? Well, the sort of the, the totality of the records that I reviewed and the interviews that I conducted um indicates that sort of before she even went to New Hampshire, she was way behind the curve. I mean, she was described at age 20 as really functioning like an early adolescent. So 1213 years old and so she’s already behind. And then now in New Hampshire, she’s living in this chronically stressed environment. Um that is sort of riddled with deprivation. She didn’t know when she was gonna get her next meal. Um Her mental health symptoms were untreated, her psychosocial mat immaturity was still present. Um And so when you think about like the the living situation and the living conditions that she experienced likely perpetuated. And in fact, I think exacerbated all of those things. And then what’s really helpful is that in the records from Catholic Medical Center and then Burwood Hospital, which was the psychiatric hospital. And then even with the records after that, when she received treatment and was at the sober living home, and I talked to her therapist, it all converges. So when, whenever I do evaluations, I look for converging information, you know, is there agreement or is there disagreement? And here there was very clear agreement that this period of time in New Hampshire perpetuated these executive functioning deficits, poor social judgment, um you know, mood liability, the psychiatric, the bipolar symptoms *** DH D in addition to the drug use and also cause these regressive behaviors. So when you sort of, when I see that agreement like that. It sort of gives me *** lot more confidence to say this was definitely present the not just that night but in the time around that incident. And so when we’re talking about lie, we are talking about all of these things going on for her at the same time. Yes, I can just have *** minute. We have no further questions at this time. Uh Doctor to the state will likely have some questions for you, have questions for this witness here. Ok. Um You may step down. Thank you, your honor.
Alexandra Eckersley trial video: Clinical and forensic psychologist testifies
Updated: 1:42 PM EDT Jul 31, 2024
VIDEO: Watch as Dr. Mathilde Pelaprat, a clinical and forensic psychologist, is called by the defense to testify at the trial of Alexandra Eckersley, who is accused of abandoning her newborn in the woods in 2022. WARNING: Some descriptions used during the trial might be disturbing for some viewers. Explicit language might also be heard. Viewer discretion is advised.
VIDEO: Watch as Dr. Mathilde Pelaprat, a clinical and forensic psychologist, is called by the defense to testify at the trial of Alexandra Eckersley, who is accused of abandoning her newborn in the woods in 2022.
WARNING: Some descriptions used during the trial might be disturbing for some viewers. Explicit language might also be heard. Viewer discretion is advised.
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