Development of a measure for assessing malingered incompetency in criminal proceedings: Denney competency related test (D-CRT).

INTRODUCTION: Experts frequently assess competency in criminal settings where the rate of feigning cognitive deficit is demonstrably elevated. We describe the construction and validation of the Denney Competency Related Test (D-CRT) to assess feigned incompetency of defendants in the criminal adjudicative setting. It was expected the D-CRT would prove effective at identifying feigned incompetence based on its two alternative, forced-choice and performance curve characteristics. METHOD: Development and validation of the D-CRT occurred in described phases. Items were developed to measure competency based upon expert review. Item analysis and adjustments were completed with 304 young teenage volunteers to obtain a proper spread of item difficulty in preparation for eventual performance curve analysis (PCA). Test-retest reliability was assessed with 44 adult community volunteers. Validation included an analog simulation design with 101 jail detainees using MacArthur Competency Assessment Test-Criminal Adjudication and Word Memory Test as criterion measures. Effects of racial/ethnic demographic differences were examined in a separate study of 208 undergraduate volunteers. D-CRT specificity was identified with 46 elderly clinic referrals diagnosed with mild cognitive impairment and dementia. RESULTS: Item development, adjustment, and repeat analysis resulted in item probabilities evenly spread from .28 to 1.0. Test-retest correlation was good (.83). Internal consistency of items was excellent (KR-20 > .91). D-CRT demonstrated convergent validity in regard to measuring competency related information and as well as malingering. The test successfully differentiated between jail inmates asked to perforfm their best and inmates asked to simulate incompetency (AUC = .945). There were no statistically significant differences found in performance across racial/ethnic backgrounds. D-CRT specificity remained excellent among elderly clinic referrals with significant cognitive compromise at the recommended total score cutoff. CONCLUSIONS: D-CRT is an effective measure of feigned criminal incompetency in the context of potential cognitive deficiency, and PCA is assistive in the determination. Additional validation using knowns groups designs with various mental health-related conditions are needed.

Integrative Care Models in Neuropsychology: A National Academy of Neuropsychology Education Paper.

Although collaborative, and more specifically, integrated models of care have existed for years, the 2010 Patient Protection and Affordable Care Act expanded their use, and Medicare has adopted a value-based payment system that further emphasizes service provision within the collaborative health care setting. Neuropsychology as a field is well-situated to work within the integrated health care setting, which presents both opportunities and challenges for clinical neuropsychologists. This education paper details how different neuropsychology clinical practice settings fit into an integrated care framework; discusses challenges to service delivery and fiscal viability in such settings and other health care related settings; and examines future directions for the role of neuropsychology within a dynamic health care system.

Use of the Rey 15-Item Test as a performance validity test in an elderly population.

The objective of this study was to determine the effectiveness of the Rey 15-Item Test in elderly individuals with and without cognitive impairment and to develop new indices to function with this population, if needed. The sample consisted of 185 individuals referred for outpatient neuropsychological evaluation. All were clinically evaluated and administered the Rey 15-Item Test (RFIT) with recognition as part of this procedure. Significant differences were present between those passing and failing the RFIT on referral question; working status; age; and diagnosis of cognitive impairment. Individuals age 60+ failed the test at rates in excess of 35%. Diagnosis also played a role with those with more severe cognitive diagnosis failing at higher rates; even in those with no diagnosis, however, 19% of elderly individuals did not produce a passing score. The extant cutoff scores commonly used with the RFIT produce unacceptably high false positive error rates to be a useful freestanding Performance Validity Test (PVT) with individuals above age 59. The introduction of a new combination score and use of rare scores and patterns of scores improves the psychometric properties of the RFIT when used with elderly adults. Cautious use of PVTs is warranted until they have been validated with aged populations.

Comparison of Performance of the VIP and WMT in a Criminal Forensic Sample.

OBJECTIVE: To compare the efficacy of the Validity Indicator Profile (VIP) and Word Memory Test (WMT) in a criminal forensic population. METHOD: Potential participants included 225 male evaluees from a maximum-security Federal prison referred for neuropsychological evaluation for either forensic purposes or for suspected neurocognitive dysfunction as part of a medical evaluation. Examinees were included in the analysis if administered the VIP (Verbal, Nonverbal, or both tests) and WMT along with at least two other freestanding PVTs; 74 satisfied these criteria. Participants were then categorized as having probable Malingered Neurocognitive Dysfunction (+MND) if they failed at least two freestanding validity indicators, negative for MND (-MND) if they passed all indicators, and Possible MND (pMND) if they failed one indicator. RESULTS: Groups were very demographically similar. There were significant differences in WMT scores and distribution of VIP profiles across groups. Whether using traditional or investigative cut scores, and whether using the WMT with or without consideration of a GMIP profile, the WMT demonstrated superior sensitivity and specificity on nearly every comparison. CONCLUSIONS: The VIP, when interpreted in the traditional fashion, and the WMT with GMIP, both had more than adequate psychometric properties when used with criminal forensic evaluees, strengthening the body of literature supporting their use for these types of evaluations. Counting a positive on either of the VIP subtests as an indication of +MND improves the psychometric properties of the VIP slightly, although the WMT had the better overall classification accuracy.

Effects of handcuffs on neuropsychological testing: Implications for criminal forensic evaluations.

Neuropsychological evaluations are increasingly performed in forensic contexts, including in criminal settings where security sometimes cannot be compromised to facilitate evaluation according to standardized procedures. Interpretation of nonstandardized assessment results poses significant challenges for the neuropsychologist. Research is limited in regard to the validation of neuropsychological test accommodation and modification practices that deviate from standard test administration; there is no published research regarding the effects of hand restraints upon neuropsychological evaluation results. This study provides preliminary results regarding the impact of restraints on motor functioning and common neuropsychological tests with a motor component. When restrained, performance on nearly all tests utilized was significantly impacted, including Trail Making Test A/B, a coding test, and several tests of motor functioning. Significant performance decline was observed in both raw scores and normative scores. Regression models are also provided in order to help forensic neuropsychologists adjust for the effect of hand restraints on raw scores of these tests, as the hand restraints also resulted in significant differences in normative scores; in the most striking case there was nearly a full standard deviation of discrepancy.

Cortical Alpha Activity in Schizoaffective Patients.

Objective: Electrophysiological studies have identified abnormal oscillatory activities in the cerebral cortex in schizophrenia and mood disorders. Biological and pathophysiological evidence suggests specific deficits in serotonin (5-HT) receptor function in schizoaffective disorder (SA), a clinical syndrome with characteristics of both schizophrenia and bipolar disorder. This study investigated alpha oscillations in patients with SA. Method: Electroencephalography was used to measure ongoing and evoked alpha oscillations in 38 adults meeting Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria for SA, and in 39 healthy controls. Results: Spontaneous alpha power of the participants with SA was significantly lower than that of healthy participants [F (1, 75) = 8.81, P < 0.01]. Evoked alpha activity was also decreased in SA compared to controls [F (1, 75) = 5.67, P = 0.025]. Conclusion: A strong reduction of alpha power in the posterior regions may reflect abnormality in the thalamocortical circuits. It is shown that hypoxia and reduced cerebral blood flow is associated with reduced alpha activity among different regions of the brain. Therefore, it can be concluded that greatly decreased alpha activity, particularly in centro-parietal and occipital regions, is related to SA symptoms such as hallucinations.

Preliminary validation of the Portuguese Edinburgh Handedness Inventory in an adult sample.

The Edinburgh Handedness Inventory (EHI) is persistently the most used inventory to evaluate handedness, being neuropsychological investigation and clinical practice. Despite this, there is no information on how this instrument functions in a Portuguese population. The objective of this study was therefore to examine the sociodemographic influences on handedness and establish psychometric properties of the EHI in a Portuguese sample. The sample consisted of 342 adults (157 men and 185 women), assessed with a battery of neuropsychological tests. The mean EHI Laterality Quotient was 63.52 (SD = 38.00). A much high percentage of ambiguous-handedness compared to left-handedness was detected. An inconsistency was found between the preference for formal education activities (writing-drawing-using scissors) and the remaining EHI activities. From sociodemographic variables, only age, area, and regions of residence showed significant influence on EHI scores. The reliability and temporal reliability of EHI were adequate. Confirmatory factor analysis indicated a one-factor model (χ2/df = 2.141; TLI = 0.972; CFI = 0.979; RMSEA = 0.058). The inconsistency between formal education and nonformal activities could be an indicator of social pressure. The present data give support for the notion that handedness measured by EHI is potentially sensitive to sociodemographic and cultural influences.

TOMM Trial 1 as a performance validity indicator in a criminal forensic sample.

OBJECTIVE: To determine the effectiveness of the Test of Memory Malingering Trial 1 (TOMM1) as a freestanding Performance Validity Test (PVT) as compared to the full TOMM in a criminal forensic sample. METHOD: Participants included 119 evaluees in a Midwestern forensic hospital. Criterion groups were formed based on passing/failing scores on other freestanding PVTs. This resulted in three groups: +MND (Malingered Neurocognitive Dysfunction), who failed two or more freestanding PVTs; possible MND (pMND), who failed one freestanding PVT; and -MND, who failed no other freestanding PVTs. All three groups were compared initially, but only +MND and -MND groups were retained for final analyses. TOMM1 performance was compared to standard TOMM performance using Receiver Operating Characteristic (ROC) analyses. RESULTS: TOMM1 was highly predictive of the standard TOMM decision rules (AUC = .92). Overall accuracy rate for TOMM1 predicting failure on 2 PVTs was quite robust as well (AUC = .80), and TOMM1 ≤ 39 provided acceptable diagnostic statistics (Sensitivity = .68, Specificity = .89). These results were essentially no different from the standard TOMM accuracy statistics. In addition, by adjusting for those strongly suspected of being inaccurately placed into the -MND group (e.g. false negatives), TOMM1 diagnostics slightly improved (AUC = .84) at a TOMM1 ≤ 40 (sensitivity = .71, specificity = .94). CONCLUSIONS: Results support use of TOMM1 in a criminal forensic setting where accuracy, shorter evaluation times, and more efficient use of resources are often critical in informing legal decision-making.

Leg Length Versus Torso Length in Pedophilia: Further Evidence of Atypical Physical Development Early in Life.

Adult men's height results from an interaction among positive and negative influences, including genetic predisposition, conditions in utero, and influences during early development such as nutritional quality, pathogen exposure, and socioeconomic status. Decreased height, reflected specifically as a decreased leg length, is strongly associated with increased risk of poorer health outcomes. Although prior research has repeatedly shown that pedophiles are shorter than nonpedophiles, the largest study to date relied on self-reported height. In the present study, pedophiles demonstrated reduced measured height and reduced leg length as compared with teleiophiles. Given the prenatal and early childhood origins of height, these findings contribute additional evidence to a biological, developmental origin of pedophilia. In addition, the magnitude of this height difference was substantially larger than that found in children exposed to a variety of early environmental stressors, but similar to that seen in other biologically based neurodevelopmental disorders.

The effect of a third party observer and trait anxiety on neuropsychological performance: the Attentional Control Theory (ACT) perspective.

OBJECTIVE: Studies have reported that the presence of a third party observer (TPO) during neuropsychological assessments negatively affects the test performance of the examinee. The present study aimed to investigate the effects of a TPO and trait anxiety on neuropsychological performance according to Attentional Control Theory (ACT). METHOD: A sample of college students was recruited (n = 318) and then 80 participants were selected to represent the high and low trait anxiety groups. Participants of each of group were randomly assigned to either the NTPO (non-TPO) or TPO conditions. The State-Trait Anxiety Inventory - Trait measure (STAI-T), Wisconsin Card Sorting Test (WCST-64), Stroop test, and Rating Scale for Mental Effort (RSME) were administered to both groups. To analyze the data, univariate ANOVAs were conducted. RESULTS: The results indicated that under the conditions without a TPO the group with high trait anxiety had poorer processing efficiency, but under the conditions with a TPO they had poorer processing efficiency and poorer performance effectiveness than the group with low trait anxiety. In addition, the group with low trait anxiety showed poorer processing efficiency in the TPO compared to non-TPO condition. CONCLUSIONS: These findings provide support for the hypotheses of ACT regarding the relation between observer presence and poorer performance on neuropsychological tests, with individuals with higher trait anxiety showing greater negative effects. Implications and suggestions for further research are discussed.

Development and psychometric properties of an informant assessment scale of theory of mind for adults with traumatic brain injury.

Impairment of theory of mind (ToM) is a common phenomenon following traumatic brain injury (TBI) that has clear effects on patients' social functioning. A growing body of research has focused on this area, and several methods have been developed to assess ToM deficiency. Although an informant assessment scale would be useful for examining individuals with TBI, very few studies have adopted this approach. The purpose of the present study was to develop an informant assessment scale of ToM for adults with traumatic brain injury (IASToM-aTBI) and to test its reliability and validity with 196 adults with TBI and 80 normal adults. A 44-item scale was developed following a literature review, interviews with patient informants, consultations with experts, item analysis, and exploratory factor analysis (EFA). The following three common factors were extracted: social interaction, understanding of beliefs, and understanding of emotions. The psychometric analyses indicate that the scale has good internal consistency reliability, split-half reliability, test-retest reliability, inter-rater reliability, structural validity, discriminate validity and criterion validity. These results provide preliminary evidence that supports the reliability and validity of the IASToM-aTBI as a ToM assessment tool for adults with TBI.

Minor Physical Anomalies as a Window into the Prenatal Origins of Pedophilia.

Evidence is steadily accumulating to support a neurodevelopmental basis for pedophilia. This includes increased incidence of non-right-handedness, which is a result primarily of prenatal neural development and solidified very early in life. Minor physical anomalies (MPAs; superficial deviations from typical morphological development, such as un-detached earlobes) also develop only prenatally, suggesting them as another potential marker of atypical physiological development during the prenatal period among pedophiles. This study administered the Waldrop Physical Anomaly Scale to assess the prevalence of MPAs in a clinical sample of men referred for assessment following a sexual assault, or another illegal or clinically significant sexual behavior. Significant associations emerged between MPA indices and indicators of pedophilia, including penile responses to depictions of children, number of child victims, and possession of child pornography. Moreover, greater sexual attraction to children was associated with an elevated craniofacial-to-peripheral anomalies ratio. The overall sample demonstrated a greater number of MPAs relative to prior samples of individuals with schizophrenia as well as to healthy controls.

Comparison of performance of the test of memory malingering and word memory test in a criminal forensic sample.

Compared with the amount of neuropsychological literature surrounding response bias in civil litigation, there is little regarding criminal cases. This study adds to the criminal forensic neuropsychological literature by comparing the Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) in a criminal forensic setting utilizing a criterion-groups design. Subjects were classified into two groups based on their performance on at least two other freestanding performance validity tests. The WMT demonstrated good sensitivity (95.1%) but poor specificity (68.4%) when Genuine Memory Impaired Profiles (GMIPs) were not considered. Inclusion of GMIPs reduced the sensitivity to 56.1% but increased the specificity to 94.7%. The TOMM evidenced better sensitivity but poorer specificity than the WMT with GMIPs. Conjoint use of the tests was also considered. Receiver operating characteristics and other classification statistics for each measure are presented. Results support the use of these measures in a criminal forensic population.

Factor structure of the Edinburgh Handedness Inventory versus the Fazio Laterality Inventory in a population with established atypical handedness.

The Edinburgh Handedness Inventory (EHI) has consistently remained the most used handedness inventory despite its limitations. The psychometric properties of handedness inventories, however, are increasingly important due to their use in matching groups for neuroimaging research. This study compared the performance of the EHI and the Fazio Laterality Inventory (FLI) in a population with atypical handedness. Whereas the EHI demonstrated a single-factor loading in this population, the FLI's previously demonstrated single factor dissociated into two factors: fine motor/ballistic movements and expressive/instrumental movements. This dissociation is similar to that seen when tests of cognitive constructs--which tend to load on a single factor in intact populations--dissociate when administered to populations with difficulties in the assessed domain. This pattern of performance lends further support for the use of the FLI to more accurately assess handedness. Future research in other populations with atypical laterality may illuminate additional factors of the FLI.

MMPI-2-RF characteristics of individuals with interstitial cystitis.

OBJECTIVES: This study aimed to describe the psychological functioning of interstitial cystitis/bladder pain syndrome patients utilizing MMPI-2-RF scoring. METHODS: The MMPI-2 was administered to 60 individuals who reported a diagnosis of IC. Responses were scored in the MMPI-2-RF format. Fifty-one protocols were deemed valid. RESULTS: Elevations were discovered on scales FBS-r (symptom validity), RC1 (somatic complaints), and MLS (malaise). Participants were split into two groups based on extreme elevations on RC1; the high RC1 group produced higher scores on 39 scales including clinically significant elevations on 17 scales. CONCLUSION: Over 25% of this sample had an emotional component to their physical concerns. This knowledge about the psychological characteristics of IC patients may have clinical utility for physicians and other treatment providers. The results argue strongly for psychological evaluation as a component of IC diagnosis and treatment. Those with significant emotional overlay to their somatic complaints may be best managed through psychological interventions and minimally invasive treatments.

Elevated rates of atypical handedness in paedophilia: theory and implications.

Multiple factors determine handedness including genetics, prenatal stress and post-natal environmental conditions. Atypical handedness, whether manifest as increased sinistrality or decreased strength of lateral preference, has been noted in a wide variety of populations with neuropathology. Those with atypical sexual preferences, specifically paedophilia, also manifest reduced rates of right-handedness. This paper uses the largest sample of phallometrically assessed men to date to establish the pattern of atypical handedness in paedophilia. Specifically, whereas prior research has largely characterized participants dichotomously as right-handed or non-right-handed and/or used self-report of writing hand, this paper expands upon such reports by using the Edinburgh Handedness Inventory's laterality quotient. Participants' handedness and phallometrically assessed sexual preference were analyzed both as continuous and categorical variables, and the responses of those scoring in the range of ambiguous-handedness were evaluated to ascertain whether they were ambiguously handed or more accurately described as mixed-handed. Results indicated those producing scores in the range of ambiguous-handedness demonstrated response patterns consistent with ambiguous-handedness, rather than mixed-handedness. Paedophiles demonstrated high rates of non-right-handedness primarily manifested as sinistrality, whereas those who had a sexual preference for pubescent children evidenced increased ambiguous-handedness. Results support a view of ambiguous-handedness as less pathological than previously hypothesized, and of a neurodevelopmental origin of paraphilic sexual preferences.

Limited predictive accuracy of the Booklet Category Test in a criminal forensic sample.

A known-groups design was used to evaluate the clinical decision rules of the validity indicators of the Booklet Category Test for the detection of malingered neurocognitive dysfunction (MND) in an incarcerated male sample. Participants were 128 inmates who were classified into MND and presumed valid groups using the Slick, Sherman, and Iverson ( 1999 ) criteria. While errors on Subtests I and II had the best classification accuracy at 71.1% with 95.1% specificity and 49.3% sensitivity, the associated area under the curve (AUC) indicated only "acceptable" discrimination due to poor sensitivity. Logistic regression confirmed that errors on Subtests I and II were the only statistically significant validity indicator. The remaining validity indicators performed poorly with AUCs at < .70, indicating no discriminative power. The effectiveness of the clinical decision rules of the validity indicators in predicting the presence of MND evidenced limited support. A positive finding on Subtest I and II errors was clinically significant in this sample, but negative results revealed no utility. Validity indices composed from different items may yield more effective results among male prisoners referred for neuropsychological evaluation.