Sunday, November 8, 2009

Research briefs 11-8-09: Competency and malingering assessment, adaptive behavior

Articles that caught my eye during my weekly search of journals.

Finkle, M. J., Kurth, R., Cadle, C., & Mullan, J. (2009). Competency Courts: A Creative Solution for Restoring Competency to the Competency Process. Behavioral Sciences & the Law, 27(5), 767-786.

It is well accepted that jail is a poor setting for treating the acutely mentally ill, yet the number of mentally ill persons in jail has increased such that Los Angeles County Jail and Riker's Island in New York house more mentally ill than any psychiatric hospital. The number of mentally ill persons charged with a crime whose competency to stand trial is in question has also increased dramatically. Inefficiencies within the competency process result in mentally ill persons charged with crimes remaining in jail longer than necessary. One solution is competency court, a specialty court within a mental health court. The same judges, attorneys, and mental health professionals staff both courts. By combining their Mental Health Court experience, they can work with the mentally ill using their expertise in competency law and processes, and thereby improve the competency process and reduce the unnecessary time that mentally ill persons spend in jail

McDermott, B. E., & Sokolov, G. (2009). Malingering in a Correctional Setting: The Use of the Structured Interview of Reported Symptoms in a Jail Sample. Behavioral Sciences & the Law, 27(5), 753-765.
The ability to detect malingering in the correctional setting is of paramount importance. The burgeoning jail and prison population combined with statutory requirements for the provision of mental health treatment require that only those most in need receive these services. Several structured assessments have been developed to assist in the identification of individuals more likely to be feigning psychiatric symptoms. Prior to the development of these specialized assessments, subscales of standard psychological tests were used as an indicator of assessment attitudes, for both malingering and other dissimulation. At the Sacramento County (CA) Jail, the Structured Interview of Reported Symptoms (SIRS) is routinely administered when clinicians feel there is a possibility that an inmate receiving psychiatric services may be feigning or exaggerating his/her symptoms. Our study examined data from these evaluations of inmates in conjunction with other clinical data (e.g., psychiatric diagnosis, educational level) to determine those factors most associated with malingering in jail inmates. Our results indicate that the prevalence of malingering in our sample was quite high: over 66% were found to be malingering based on the scoring criteria for the SIRS. Inmates diagnosed with Antisocial Personality Disorder were no more likely to feign symptoms than inmates without this diagnosis. Inmates designated as malingering in their charts were no more likely to be found malingering on the SIRS, suggesting that they may have adopted an effective strategy

Salekin, K. L., & Doane, B. (2009). Malingering intellectual disability: The value of available measures and methods. Applied Neuropsychology, 16, 105-113.
Atkins v. Virginia (2002) is a case that has changed the landscape in relation to the assessment of malingering in a legal context. This landmark decision abolished the death penalty for defendants found to have intellectual disability (ID; formally known as mental retardation), but limitations in our assessment techniques lead to questions regarding the veracity of ID claims. In fact, Justice Scalia noted with clarity that concerns exist regarding the ability of individuals to feign ID and to do so successfully. At the time of writing, little empirical research has been completed, but that which exists demonstrates an overall lack of validity for traditional measures of cognitive malingering for use with this population. This manuscript provides an overview of the utility of many of the traditional measures of malingering for use with an ID population and serves as a call for research in this very important area.   
Doane, B., & Salekin, K. L. (2009). Susceptibility of current adaptive behavior measures to feigned deficits. Law and Human Behavior, 33, 329-343.
The current study examined the susceptibilityof the Adaptive Behavior Assessment System—2nd edition(ABAS-II; Harrison & Oakland, 2003) and the Scales of Independent Behavior—Revised (S1B-R; Bruininks, Woodcock, Weatherman, & Hill, 1996) to the feigning of adaptive functioning deficits. Using four different instruction sets, the authors evaluated whether the provision of diagnostic information (a form of coaching) improved participants’ ability to simulate adaptive deficits commensurate with a diagnosis of mental retardation. The authors found that the ABAS-II was quite vulnerable to believable manipulation by raters, while the SIB-R was not. In fact, exaggeration on the SIB-R was easily detected regardless of the information provided. Implications regarding the use of these measures in Atkins mental retardation evaluations are discussed.

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