No abstract

Intact cognition is a foundational component of one's ability to be competent to stand trial. Given the cost of assessing and treating incompetence, it is recommended that clinicians develop efficient methods to identify individuals who are most likely to require intensive competence-related treatment interventions. This study sought to ascertain whether a brief cognitive screening instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), could predict the length of stay required to restore trial competency among 288 forensic psychiatric inpatients undergoing competency restoration treatment. Results indicated that incompetent defendants who were older or demonstrated poorer overall RBANS performance required longer hospitalizations to be deemed restored to trial competence. Interestingly, incompetent defendants scoring in the 51-60 range on the RBANS Total Scale Index were almost three times more likely to require hospitalization beyond the average length of stay. Findings support the use of the RBANS to identify individuals early in the treatment process who may require and benefit from intensive restoration treatment.

Recent research (Erdodi et al., 2017) indicated that certain Wechsler Adult Intelligence Scale (WAIS-IV) Processing Speed Index (PSI)-based indices may have some utility as embedded validity indicators (EVIs) among a diagnostically diverse sample of neuropsychology referrals. Individuals with schizophrenia spectrum disorders (SSD) are often evaluated in forensic contexts in which there is incentive to exaggerate deficits. Because individuals with SSD often have limitations in processing speed associated with their disorders, the current study sought to evaluate the false-positive (FP) rates of cutoffs identified by Erdodi et al. on WAIS-IV PSI-based EVIs among forensically committed psychiatric inpatients with SSD who had no known incentive to feign because of the nature of their legal commitments. In the current sample, the previously suggested cutoff scores on PSI-based EVIs resulted in FP rates ranging from 2% to 57% among schizophrenia spectrum patients, with unacceptable FP rates for most indices. In the current sample of SSD patients, WAIS-IV PSI-based EVIs that are calculated based on the relative performance between PSI subtests (as opposed to absolute performance on individual indices) demonstrated acceptable FP rates. (PsycINFO Database Record

The Rey Word Recognition Test potentially represents an underutilized tool for clinicians to use in the detection of suspect effort. The present study examined the predictive accuracy of the test by examining the performance of three groups of participants: (a) 92 noncredible patients (as determined by failed psychometric and behavioral criteria and external motive to feign), (b) 51 general clinical patients with no motive to feign, and (c) 31 learning disabled college students. Results demonstrated gender differences in performance that necessitated separate cutoff scores for men and women. Use of a cutoff score of < or = 7 words correctly recognized identified 80.5% of noncredible female patients while maintaining specificity of > 90%. However, to achieve this level of specificity in male noncredible patients, the cutoff score had to be lowered to < or = 5, with resultant sensitivity of only 62.7%. A combination variable (recognition correct minus false positive errors + number of words recognized from the first 8 words) showed enhanced sensitivity in identifying suspect effort in a subset of the noncredible sample who were claiming cognitive symptoms secondary to traumatic brain injury (i.e., cutoff score of < or = 9 = 81.6% sensitivity with 90% specificity). Results indicate that the Rey Word Recognition Test is an accurate and cost-effective method for the detection of noncredible cognitive performance.

Two studies were conducted to identify and cross-validate cutoff scores on the Wechsler Adult Intelligence Scale-Fourth Edition Digit Span-based embedded performance validity (PV) measures for individuals with schizophrenia spectrum disorders. In Study 1, normative scores were identified on Digit Span-embedded PV measures among a sample of patients (n = 84) with schizophrenia spectrum diagnoses who had no known incentive to perform poorly and who put forth valid effort on external PV tests. Previously identified cutoff scores resulted in unacceptable false positive rates and lower cutoff scores were adopted to maintain specificity levels ≥90%. In Study 2, the revised cutoff scores were cross-validated within a sample of schizophrenia spectrum patients (n = 96) committed as incompetent to stand trial. Performance on Digit Span PV measures was significantly related to Full Scale IQ in both studies, indicating the need to consider the intellectual functioning of examinees with psychotic spectrum disorders when interpreting scores on Digit Span PV measures.