Assessing Negative Response Bias in Competency to Stand Trial Evaluations

Assessing Negative Response Bias in Competency to Stand Trial Evaluations provides a comprehensive guide to assessing malingering, feigning, poor effort, and lack of cooperation in competency to stand trial (CST) examinations. It draws on both the author’s extensive experience as a CST examiner and the vast, dynamic professional literature from forensic psychology, clinical psychology, and neuropsychology on assessing response style. The assessment process is considered from beginning to report writing and testimony, with tips regarding interview strategies, fact patterns and behaviors suggestive of feigning, testing, and creative and ethical use of collateral data. Every major validity test used by CST examiners is thoroughly and critically reviewed, as are others that are promising and not yet widely adopted. This includes self-report inventories such as the MMPI-2, MMPI-2-RF, PAI, and SIMS; structured interviews like the SIRS, SIRS-2, and M-FAST; performance validity tests like the TOMM, VIP, 15 item Test, and WMT; and CST-specific tests like the ILK and ECST-R Atypical Presentation Scales. A complete chapter is devoted to means to summarize and combine data from different tests and sources, and another to special populations such as defendants who claim amnesia, are intellectually disabled, or are adolescents. Report writing and testimony considerations are discussed in detail, with implications for the assessment and practice. In Chapter 10, CST examiners’ practices, including preferences for tests and collateral sources, are reported along with the perceived prevalence of various invalid presentation styles. Finally, policy implications of feigning and suggestions for cost-effective practice are provided.

Introduction

This chapter introduces the reader to negative response bias—malingering, feigning, and lack of cooperation, and their prevalence in competency to stand trial evaluations. The chapter cites a number of studies that examined the rate of feigning in competency assessments and identifies factors that are likely to affect the base rate of feigning. Styles of negative response bias are also discussed, as is the possibility that a legitimately mentally ill defendant might deny psychiatric problems. Finally, the chapter summarizes recent legal decisions, from both state and federal jurisdictions, that comment on feigning or malingering in the context of a CST evaluation or hearing.

Systemic, Policy, and Research Issues

This chapter briefly recaps the major findings from the preceding chapters and discusses the enormous implications of the transition from inpatient to outpatient CST assessment over the past 20 years. Along with low fees for outpatient CST examinations, this shift to outpatient assessment has led to a greater urgency for examiners to be able to address negative response bias in a time-efficient manner. The chapter reviews the time requirements for various validity tests and other data that may inform validity assessment; it also considers advantages or disadvantages of the location of evaluations and provides recommendations regarding situations in which a second opinion CST exam is ordered. Recommendations for public policy and future CST research are offered.

Faking ADHD? Symptom Validity Testing and Its Relation to Self-Reported, Observer-Reported Symptoms, and Neuropsychological Measures of Attention in Adults With ADHD

Objective: To compare ADHD patients who failed a symptom validity test with those who passed the test to explore whether there are signs of negative response bias on group level. Method: In our outpatient department, 196 adults were diagnosed with ADHD using a comprehensive diagnostic strategy featuring a detailed clinical history, clinical interview, observer rating, several self-rating scales, and neuropsychological attention tests. The Amsterdam Short Term Memory Test (AKGT) was applied as a symptom validity measure. Results: Sixty-three patients (32.1%) scored below the AKGT cutoff level. The two groups did not significantly differ regarding self-report and observer ratings. Those who failed the AKGT had higher reaction time variabilities in selective, auditory and visual divided attention, and higher omission errors in sustained attention. Conclusion: We found no strong indicators for negative response bias in ADHD patients who failed a symptom validity test. New measures and approaches to detect feigned ADHD should be developed.