Detection strategies for malingering with the Miller Forensic Assessment of Symptoms Test: a confirmatory factor analysis of its underlying dimensions

Two of the most widely used measures for the assessment of malingering in forensic populations are the Miller Forensic Assessment of Symptoms Test (M-FAST) and the Structured Interview of Reported Symptoms (SIRS). The underlying dimensions of the SIRS have been well established in the literature, but the structure of the M-FAST remains relatively untested. Understanding of its dimensions is critical for construct validity and guiding its proper use. Confirmatory factor analysis was used to provide evidence of a single parsimonious malingering factor to account for the covariation of the M-FAST items in a sample of 244 forensic patients. In addition, the model was cross-validated with an independent sample of 210 forensic patients. Finally, the M-FAST factor was modeled in conjunction with two factors of the SIRS. Results provide further validation of the underlying detection strategy found in the M-FAST.     

Utilizing physiological measures to facilitate phobia treatment with individuals with autism and intellectual disability: A case study

Despite the conceptualization of phobic fear as a multi‐factorial response, the measurement and treatment of phobias is often not comprehensive. The extant literature on the treatment of phobias for individuals with intellectual disabilities has exclusively focused on indices of behavioral avoidance. The present study demonstrates the treatment of behavioral avoidance and physiological reactivity in a child diagnosed with autism, intellectual disability, and a dog phobia. The results indicate that the individual often experienced physiological reactivity in the presence of the feared stimulus despite engaging in behavioral approach. Treatment of both behavioral avoidance and physiological reactivity resulted in successful generalization of treatment effects across three additional dogs and maintenance of treatment effects during a six‐month follow‐up assessment. Implications for examining multiple aspects of the anxious response when treating children with intellectual disabilities and severe language delays are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

A survey of psychological test use patterns among forensic psychologists

Clinical psychologists are frequently called on to testify in court regarding mental health issues in civil or criminal cases. One of the legal criteria by which admissibility of testimony is determined includes whether the testimony is based on methods that have gained "general acceptance" in their field. In this study, we sought to evaluate the psychological tests used in forensic assessments by members of the American Psychology-Law Society Division of the American Psychological Association, and by diplomates in the American Board of Forensic Psychology. We present test results from this survey, based on 152 respondents, for forensic evaluations conducted with adults using multiscale inventories, single-scale tests, unstructured personality tests, cognitive and/or intellectual tests, neuropsychological tests, risk assessment and psychopathy instruments, sex offender risk assessment instruments, competency or sanity-related instruments, and instruments used to evaluate malingering. In addition, we provide findings for psychological testing involving child-related forensic issues.     

Reducing hoarding behavior with individualized reinforcement and item return

Treatment research on hoarding is generally limited to people without intellectual disabilities who have symptoms of obsessive compulsive disorder and respond favorably to cognitive‐based therapies. We evaluated the effects of individualized reinforcement and item return procedures on hoarding behavior in a multiple baseline across three persons with severe mental retardation. Systematic preference assessment procedures identified items used in the individualized reinforcement procedures. Reductions in hoarding behavior occurred for each person when individualized treatment and item return procedures were applied. These reductions were maintained when direct support staff were trained to provide treatment. Copyright © 2006 John Wiley & Sons, Ltd.     

Solidarity and Reciprocity Between People With and Without Disabilities

Governments of contemporary welfare states call upon citizens to care for people with psychiatric or intellectual disabilities. This is deemed sensible and morally just. However, social–psychological theory suggests that stereotyping may stand in the way of engaging into contact. Sociological theory suggests that the giving of help is based on either balanced or generalized reciprocity. Balanced reciprocity depends on one's ability to ‘pay back’, which people with disabilities may have trouble doing. Generalized reciprocity depends on close social bonds, while people with disabilities often have fewer social bonds than other citizens. The current study aimed to find out whether citizens—despite socio‐psychological and sociological theories expecting otherwise—enter into supporting relationships with people with intellectual or psychiatric disabilities. Although we found socio‐psychological and sociological theory to be largely correct, we also found people to be more creative than theory assumes. A smile can be experienced as a return gift, thus including people with intellectual disabilities in the web of balanced reciprocity. Some people create new social bonds to include people with disabilities: they feel close to them because they had a job in the healthcare sector or because they had a family member with a disability. In disadvantaged neighbourhoods, recognition of each other's problems can create feelings of similarity and concomitant reciprocity. Copyright © 2016 John Wiley & Sons, Ltd.     

An empirical approach to the classification and treatment of maximum security psychiatric patients

Treatment approaches with forensic patients have traditionally been nonspecific and have been based primarily on legal or diagnostic categories. The current study, stimulated by the need to reorganize treatment and assessment services, examined the incidence among 189 maximum security psychiatric patients of 70 problems commonly exhibited either in the community prior to admission or within the institution. Through a series of factor and cluster analyses, a model for the placement and treatment of these patients was developed that included assaultiveness, level of functioning, social withdrawal, and active psychotic symptoms.     

The Effectiveness of Audiovisual Self-Instructional Materials in Teaching Child-Care Skills to Parents with Intellectual Disabilities

Children of parents with intellectual disabilities are at risk for neglectful care due to parenting skill deficiencies. Previous studies have shown that parents with intellectual disabilities can improve child-care skills with intensive behavioral training, but self-instruction has not been explored. We evaluated the efficacy of self-instructional pictorial child-care manuals with and without accompanying audiotaped instruction using a multielement design with 13 parents with intellectual disabilities. The self-instructional materials were effective in teaching 22 of 26 skills to levels seen in parents without intellectual disabilities. Eighty-one percent of the skills maintained over a 1-15 month follow-up period and self-learning effects were replicated when the parents received self-instructional materials for the original no-training control skill. Despite the low literacy skills of the parents, for most of them no advantage was found in adding the audiotape to the illustrations. Three parents only reached criterion after an audiotape was added to the manual alone skill. Consumer satisfaction ratings were uniformly high and those parents who stated a preference, preferred the pictorial manuals without, as opposed to with, the audiotape. These findings suggest that a majority of parents with intellectual disabilities may improve their parenting skills with low cost, low tech, self-instructional materials.     

Cross‐examination: The Testimony of Children With and Without Intellectual Disabilities

The present study assessed how children with a range of cognitive abilities fared during a mock cross‐examination. Ninety children (aged 4 to 11 years; 18 with intellectual disabilities, 13 with borderline intellectual disabilities and 59 who were typically developing) witnessed a staged event, participated in an initial forensic interview (a few days later) and were cross‐examined by a barrister‐in‐training (10 months later). During cross‐examination, 98% of all children changed at least one response from their initial interview when challenged. However, group differences in performance (total number of changed responses, ‘resistance’ to challenges), controlling for age and memory for event details, were not significant or did not prove reliable at the level of individual group contrasts. Overall, little robust evidence for group differences in performance on cross‐examination could be identified, and memory for event details was the most reliable predictor of performance. Copyright © 2013 John Wiley & Sons, Ltd.     

The Assessment and Diagnosis of Attention Deficit Hyperactivity Disorder in Adult Forensic Psychiatric Outpatients

The primary purpose of the present study was to examine the validity of commonly utilized ADHD rating scales within an adult forensic population. Participants were 120 patients assessed for dysfunctional anger and impulsive aggression at a hospital-based clinic. Two psychiatrists made independent diagnoses about the presence or absence of ADHD among individuals presenting with symptoms consistent with this disorder. Following the diagnoses, participants were assessed with multiple ADHD measures, including measures based on self-report, observer-report, or a computerized neuropsychological measure (IVA + Plus). With the exception of the IVA + Plus, the ADHD measures significantly differentiated individuals diagnosed with ADHD from individuals who were not so diagnosed. These measures also demonstrated good diagnostic utility via test specific parameters (sensitivity, specificity, positive predictive power, and negative predictive power). A sub-set of measures demonstrated particularly good classification accuracy, with high sensitivity (91 %) and good specificity (81 %). Implications of these findings for the effective assessment and diagnosis of ADHD in adult outpatient psychiatric settings are discussed.     

Bedeutung des Intelligenzquotienten für die Feststellung des Eingangsmerkmals Schwachsinn im Sinne der §§ 20, 21 StGB

Disorders in cognitive capacity, as defined in § 20 of the German legal code, are responsible for a relevant proportion of the population sentenced to treatment in forensic psychiatry in Germany. Historically one of the first conditions for diminished culpability, it refers primarily to the level of cognitive functioning. In routine psychiatric treatment of people with intellectual disability other aspects, such as emotional and social development became more and more relevant. This article explains that these aspect should be more involved in the process of forensic assessment or at least give rise to discussion and makes proposals for a modification of exculpation criteria due to the German legal code.     

Assessment of Depression and Suicidal Actions: Agreement between Suicide Attempters and Informant Reports

Knowledgeable informants may be able to provide useful information about depressive symptoms and suicidal actions when a suicidal patient is uncooperative with a clinical interview or not available for a psychiatric evaluation. The present study was designed to examine information gathered from psychiatric inpatients who had attempted suicide as compared to similar information obtained from a close friend or family member. From a larger sample of adult psychiatric inpatients diagnosed with major depression, 25 suicide attempters were assessed and their reports were compared to similar information solicited from a close friend or family member. The assessment focused on depressive symptoms from the SCID and the presence of various suicidal actions. Moderate to high agreement was found on all measures. Psychiatric patients and their informants tended to agree on the presence of depressive symptoms, the presence of recent stressful life events, and specific actions taken during the suicidal crisis, suggesting that informants may be capable of providing useful information about the patient.     

Validity of the Brief Psychiatric Rating Scale Within a Forensic Inpatient Hospital

Although the Brief Psychiatric Rating Scale(BPRS) has been utilized across several clinical settings, its potential utility within forensic psychiatric hospitals has not yet been investigated. Given the diversity of training and background among correctional mental health workers (i.e., psychiatrists, psychiatric nurses, occupational therapists, recreation therapists, psychologists, social workers,etc.) it is possible that the uniform use of the BPRS among the correctional staff would require extensive training and that substantial “refresher” training may be required to maintain the integrity of rater practices. The present study examined the ability of previously trained forensic mental health professionals to accurately assess psychopathology using the BPRS. Overall,experienced raters demonstrated relatively high concordance rates with “gold standard” ratings across three BPRS training videos (Case 1, Case2 and Case 3). No overall “rater drift” was apparent. However, raters were found to make significantly more errors when rating behavioral observation ratings than for ratings based on self-report patient statements. Findings suggest that ratings done by forensic mental health workers are relatively accurate when compared to “gold standard” ratings established for assessment of community and forensic psychiatric patients. This revised version was published online in July 2006 with corrections to the Cover Date.     

Intelligenzgeminderte Rechtsbrecher im Maßregelvollzug

Forensic patients with intellectual disabilities have so far received little attention which is reflected in the comparatively briefly written chapters in the standard textbooks and also the low scientific interest in this patient group. There are only few therapeutic concepts and even less information on their effectiveness. This article presents the Christophorus Clinic in Münster which was the first forensic institution in Germany to specialize in these patients. The institution incorporates 54 treatment places and started operating on 3 June 2011. In addition to the known fact that a therapy concept must (further) develop over the years, during the first year of operation some aspects have arisen which have cristallized as problem areas specific for this patient group, which are discussed.     

Poverty and people with intellectual disabilities

Epidemiological studies have consistently reported a significant association between poverty and the prevalence of intellectual disabilities. The available evidence suggests that this association reflects two distinct processes. First, poverty causes intellectual disabilities, an effect mediated through the association between poverty and exposure to a range of environmental and psychosocial hazards. Second, families supporting a child with intellectual disabilities and adults with intellectual disabilities are at increased risk of experiencing poverty due to the financial and social impact of caring and the exclusion of people with intellectual disabilities from the workforce. It is likely that the association between poverty and intellectual disabilities accounts in part for the health and social inequalities experienced by people with intellectual disabilities and their families. Implications for policy and practice are discussed in relation to the funding of services for people with intellectual disabilities and preventative approaches to addressing the health and social inequalities experienced by people with intellectual disabilities and their families.     

Umgang mit gefährlichen Straftätern in England und Wales

Forensic psychiatric institutions exist in all western European countries. Their organisation depends on a number of factors including the legal framework and societal attitudes towards mentally disordered offenders. This article describes and critically comments on the forensic psychiatric system in England and Wales, its legal framework and approaches to dealing with dangerous offenders. England and Wales have a long forensic psychiatric tradition with the first high security hospital, Broadmoor hospital, having been established in 1863. Evidence-based treatment approaches in forensic hospitals as well as in prisons, training of forensic psychiatrists and research in the field of forensic psychiatry have gained international recognition. However, there are some worrying aspects in the system of forensic psychiatric care and the criminal justice system more generally, in particular the high and still increasing number of prisoners in comparison with other European countries, the low age of criminal responsibility, long sentences, increasing length of stay in forensic care and the increasingly risk averse culture. A number of differences to the German system can be found; one such difference relates to the role of criminal responsibility which is irrelevant for decisions regarding commitment in England and Wales. Only the mental state and need for treatment at the time of trial (or later assessment in prison) determine whether an offender is admitted to psychiatric care or receives a prison sentence. A number of new initiatives have been launched in recent years resulting in an increasing number of individuals being detained in forensic psychiatric and criminal justice institutions, in particular the initiative for the detention and treatment of individuals with so-called dangerous and severe personality disorders, the sexual offenders register and the new sentence of indeterminate imprisonment for public protection. These initiatives have been the subject of a number of complaints to the European Court of Human Rights. Nevertheless, the trend towards a more and more risk averse culture continues.     

The predictive validity and practical utility of structured schemes used to assess risk for aggression in psychiatric inpatient settings

There has been increased interest in structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. The most commonly utilized schemes are those previously developed to assess risk for prisoners being considered for release on parole and for forensic psychiatric patients being considered for discharge from the hospital to the community. Few structured schemes have been developed with the explicit aim of assessing risk for aggression in the inpatient setting. Recent research utilising a variety of risk assessment schemes has revealed reasonable predictive validity. This narrative review summarizes and appraises this expanding literature within the context of risk assessment decision making tasks typically undertaken by psychiatric unit staff. It is concluded that a number of structured risk assessments schemes do have acceptable predictive validity. Unfortunately, many of the schemes tested are compromised by a lack of practical utility, and only a few are capable of contributing to the entire range of risk assessment decision making tasks required. Options for the application of structured risk assessment schemes are raised.     

Dimensions of self-serving misrepresentation in forensic assessment

I conducted an exploratory principal components analysis of 15 scales that evaluate a variety of possible self-serving biases using assessment data from 101 general forensic clients. Three distinct factors emerged, representing exaggeration of psychiatric symptoms versus exaggeration of personal adjustment, exaggeration of virtue, and exaggeration of physical health difficulties. Confirmatory factor analysis supported the findings. The surprising fact that none of the scales contained a significant number of items representing the affirmation or exaggeration of positive mental health adjustment precluded the possibility of finding a specific factor in that area. The factor structure was similar to previous results based on personal injury evaluations alone, suggesting that this 3-factor categorization of self-serving misrepresentation has some degree of generality, at least in forensic settings.     

Expressed emotion in families of children and adults with intellectual disabilities

Expressed emotion (EE) is a measure of the affective relationship between two people characterized by criticism, hostility, and emotionally over-involved attitudes. Outside of the field of intellectual disabilities, there has been considerable interest in EE as an environmental marker that explains variance in the severity and/or course of a number of psychiatric disorders. Researchers have also studied EE in parents and found strong associations with children's behavior problems. In this review, we focus on the data from 11 published studies of EE in families of children and adults with intellectual disabilities. We conclude that there is evidence for the presence of high EE in some families, and that this alone should concern researchers and clinicians and set an agenda for considerable future research effort. We also note a lack of attention to the measurement of EE in intellectual disability. In terms of the existing evidence base, we suggest that there is support for the hypothesis that behavior problems in children and adults with intellectual disabilities may be related to high EE in parents, and a small amount of data predicting over time support the putative causal effect of high EE on maintaining or exacerbating behavior problems. Given that EE is perhaps best conceptualized as the result of an interaction between caregivers and those cared for, there is a need to explore interventions that may help to remediate high EE within families. It is also important to understand from this position that EE may be a normative part of the experience of caring for someone under very stressful circumstances and not something for which families are blamed. Other future research priorities and some implications for practice are also discussed.     

Dual diagnosis in an Australian forensic psychiatric hospital: prevalence and implications for services

Despite a growing awareness of the unique needs of psychiatric patients with co-occurring substance abuse and dependence disorders (i.e. dual diagnosis), there is a dearth of research investigating the prevalence of dual diagnosis in forensic psychiatric populations. Similarly, little work has been done to determine the implications of dual diagnosis for forensic psychiatric patients. Patients at the Thomas Embling Hospital in Victoria, Australia, were assessed to determine the prevalence of substance abuse disorders and mental illnesses within this population. Results reveal that the majority of patients (approximately 74%) have a lifetime substance abuse or dependence disorder. Information was collected concerning patients' criminal histories and the Level of Service Inventory, Revised, was completed for each patient who participated. Results suggest that patients with both major mental illnesses and substance abuse disorders have more extensive criminal histories and demonstrate a higher level of risks and needs when compared with patients with major mental illness alone. The implications for the development and delivery of effective forensic mental health services that address both co-occurring disorders are also discussed.     

Gender Differences in Victimization and the Relation to Personality Disorders in Forensic Psychiatry

Gender differences in victimization were retrospectively examined in 218 male and 218 female patients who have been admitted to one of four Dutch forensic psychiatric hospitals between 1984 and 2014. Case files were studied and variables relating to victimization and psychopathology were coded. It was found that the prevalence rates of victimization were higher among female patients than among male patients, both during childhood and adulthood. Childhood sexual abuse was found to be more prevalent among women than men, however, no differences were found for emotional and physical abuse or neglect during childhood. Women with a history of emotional or sexual abuse were significantly more often diagnosed with borderline personality disorder than women without childhood victimization. Men with a history of physical abuse were significantly more often diagnosed with antisocial personality disorder than men without childhood victimization. Clinical and policy implications of this study for forensic practice are discussed.