Psychological Assessment of Symptom and Performance Validity,Response Bias,and Malingering: Official Position of the Association for Scientific Advancement in Psychological Injury and Law

Evidence-based forensic psychological opinions require thorough and accurate information about examinees. Psychometric instruments can facilitate diagnostic decision making, but they rely on examinees to respond honestly to questions and put forth good effort on cognitive tests. Given the strong incentives for examinees in psychological injury cases to minimize prior problems and emphasize postaccident or posttrauma problems, the assessment of validity as part of forensic psychological evaluations is essential. Best practices in forensic psychology have their foundation in ethical principles. The purpose of this position statement is to promote ethical psychological practice in legal contexts by reviewing validity assessment issues and their ethical foundations. Because no previously published document focused specifically on symptom and performance validity assessment in psychological injury evaluations performed in forensic contexts, such a position statement provided by a professional organization devoted to the interface of psychological injury and law was needed to inform and guide practitioners and to educate other interested parties. The position statement emphasizes (a) the need for ethical practice in assessing validity, (b) consideration of factors such as culture and functional limitations, and (c) the importance of adopting a comprehensive, impartial, and scientific approach to validity assessment. The position statement acknowledges areas of differing opinions and the need for further research.     

Coping in Psychological Injury: A Biopsychosocial and Forensic Perspective

This paper examines stress and coping from the perspective of psychological injury, which concerns injuries attributed to an event at claim. The paper explores current conceptualizations of stress and coping and includes discussion of resilience. In particular, the paper focuses on biopsychosocial approaches, given their relevance to the area of psychological in jury and law. The paper presents a model of coping that integrates biopsychosocial and forensic aspects. As part of the model, the author develops the concept of forensic appraisals, which are particular to the area of psychological injury and law. The paper discusses implications for practice and assessment.     

Using a Five-Stage Model to Evaluate Workplace Discrimination Injuries

Psychological assessment for workplace discrimination injuries is often complex, as each complainant has a particular personal history and context, including different coping skills, psychopathologies and unique life circumstances. A five-stage model based on best practice guidelines can assist forensic assessment practitioners in determining compensatory damages for psychological or psychiatric injuries and in formulating defensible, evidence-based reports that meet legal standards. The model incorporates legally relevant theories of causation to guide the evaluating psychologist to discern the nature and extent of any injury, and whether discrimination was the likely proximate cause. The focus is not on diagnosis but on functional performance (cognitive, affective, interpersonal and physical) in four key contexts: activities of daily living, relationships, the workplace and hedonic pursuits. This assessment method compares functioning in the complainant’s life until the “day before” the alleged discrimination event with the complainant’s condition at the time of the alleged discrimination, and any symptoms or reactions experienced subsequently. The five-stage model provides a systematic method to examine compensatory damages claims and increase the comprehensiveness and accuracy of the forensic evaluation.     

Neuropsychological,Psychological, and Vocational Assessment of High Achievers in a Medicolegal Context

High achievers are a unique subset of persons referred for neuropsychological and psychological assessments in medicolegal contexts, including personal injury, disability, and workers’ compensation cases. Literature in this area is limited and poorly integrated, and neither a conceptual model nor best evidence-informed practices for the assessment of high achievers in the medicolegal context have yet emerged. Construct and methodological issues also hamper the ability of assessors to accurately and fairly assess this specialist group, which is particularly troubling in high-stakes forensic assessments. This paper reviews the current methodological issues involved in the assessment of high achievers and proposes an integrated, multimethod assessment model based on a particular vocational group, namely that of business leaders and entrepreneurs, that draws from available empirical research in different fields of psychological inquiry.     

The Quality of Forensic Psychological Assessments,Reports, and Testimony: Acknowledging the Gap Between Promise and Practice

During the past decade, the field of forensic psychological assessment entered a period of standard setting, reflected in the publication of specialty guidelines for practice and in the proliferation of educational opportunities, training programs, and credentialing and certification procedures for forensic examiners. Representing significant efforts to advance the quality of psychological assessments in legal contexts, these developments foreshadow the promise of forensic assessment. During this same time period, new evidence emerged regarding the quality of forensic practice. This article reviews this evidence and evaluates current practice against the promise of forensic assessment. Forensic reports appear to be of higher quality than those described by commentators in the 1970s and early 1980s; nevertheless, the level of practice falls far short of professional aspirations for the field. The review identifies significant areas of weakness that demand the attention of professional organizations, accrediting agencies, educators, lawmakers, practitioners, and consumers.The truth is what is, not what should be.--Lenny Bruce     

Forensic mental health assessment in France: Recommendations for quality improvement

The quality of forensic mental health assessment has been a growing concern in various countries on both sides of the Atlantic, but the legal systems are not always comparable and some aspects of forensic assessment are specific to a given country. This paper describes the legal context of forensic psychological assessment in France (i.e. pre-trial investigation phase entrusted to a judge, with mental health assessment performed by preselected professionals called “experts” in French), its advantages and its pitfalls. Forensic psychiatric or psychological assessment is often an essential and decisive element in criminal cases, but since a judiciary scandal which was made public in 2005 (the Outreau case) there has been increasing criticism from the public and the legal profession regarding the reliability of clinical conclusions. Several academic studies and a parliamentary report have highlighted various faulty aspects in both the judiciary process and the mental health assessments. The heterogeneity of expert practices in France appears to be mainly related to a lack of consensus on several core notions such as mental health diagnosis or assessment methods, poor working conditions, lack of specialized training, and insufficient familiarity with the Code of Ethics. In this article we describe and analyze the French practice of forensic psychologists and psychiatrists in criminal cases and propose steps that could be taken to improve its quality, such as setting up specialized training courses, enforcing the Code of Ethics for psychologists, and calling for consensus on diagnostic and assessment methods.     

Development of a computerized sexual assessment laboratory

Computer-assisted psychological assessment has been operational for 25 years. It has been well received by patients and shows a degree of reliability that is comparable to that of conventional testing. The authors report on the development of a computerized psychosexual assessment laboratory in a forensic facility housing convicted sex offenders who volunteered for treatment. The development of the laboratory was in response to the need for uniform psychosocial data on each resident that can be used for making better diagnoses, developing personalized treatment programs, and assessing treatment outcome. The process of selecting the psychological tests and programming them for interactive administration is described, as are the testing procedures using the penile plethysmograph with stimuli based on the Tanner developmental stages. A computer-assisted psychosocial assessment that produces a psychosocial history was developed. The laboratory's overall value in the treatment program is assessed.     

Forensic psychiatry: a subspecialty. The presidential address at the nineteenth annual meeting of the American Academy of Psychiatry and the Law

The implications of the definition of forensic psychiatry are explored, with particular reference to the field as a subspecialty of general psychiatry. The allegation of undue moral uncertainty in forensic psychiatry is denied and the moral issues are revealed to be related to the status of the underlying philosophical disputes. An outline for the organization of the forensic psychiatric assessment is presented. The charge that forensic psychiatry is not as "hard" a science as the other forensic sciences is denied. The administrative and political organizational problems facing the subspecialty are explored. The practitioners in the field are encouraged to recognize that forensic psychiatry is a subspecialty and to work for official subspecialty status. Cautious predictions about the future of the field are provided.     

Using the International Classification of Functioning, Disability and Health (ICF) to Conceptualize Disability and Functioning in Psychological Injury and Law

The International Classification of Functioning, Disability, and Health (ICF) is the World Health Organization’s classification of human functioning and disability. The ICF is addressed as an important development in healthcare and of specific importance for informing assessment in forensic psychology. The utility of the conceptual framework of the ICF to inform case conceptualization in psychological injury and law is explored. Future prospects for the ICF in psychological healthcare are reviewed, including the need for more research on the intersection of the ICF and the psychological–legal context.     

Disentangling the Disability Quagmire in Psychological Injury and Law

This paper aims to critically analyze the evolution of six models of conceptualization, determination, and prediction of occupational disability relevant in the medico-legal context of psychological injury. The six models are the (a) biomedical, (b) forensic, (c) psychosocial, (d) ecological, (e) economic, and (f) biopsychosocial. We will discuss the key commonalities and differences among the models, including disciplinary tradition, research paradigm, recognition of person–environment interaction, key tenets, and implications for practice and research in psychological injury. The paper will highlight and discuss psychosocial issues, often underemphasized in forensic psychological practice, including: (a) balanced assessment of primary, secondary, and tertiary gains and losses, (b) self-perception, (c) disability identity, (d) beliefs and expectations, (e) coping, (f) adaptation and positive growth, (g) social stigma and social reactions to disability, including disability harassment, and (h) recognition of system-based environmental influences and demands. We will provide a special focus on the current state of the science and practice of prediction of disability, of particular interest to researchers and clinicians involved in clinical and occupational prognostication in psychological injuries. Finally, we will draw conclusions and recommendations for future research and best practices in the psychological injury area using a cross-diagnostic, dynamic, functionally based, and integrated biopsychosocial and forensic model of disability.     

Forensic Assessment of Adults Reporting Childhood Sexualized Assault: a Lifespan Developmental Analysis

Many adults reporting childhood or adolescent sexualized assault (CSA) seek remedies through civil proceedings, thus necessitating a forensic assessment to determine the nature and extent of any psychological injuries related to such assault. Such assessments pose challenges, as CSA often occurred years earlier and may have affected not only immediate functioning but also later psychological maturation. The present paper explains how a lifespan developmental analysis can assist such assessments. The concepts of psychological development, attachment, developmental trajectory and risk and resilience can help in evaluating whether and how CSA affected normal psychological development, in determining the influence of risk factors other than CSA and in considering resiliency factors. Risk, resilience and psychological function must be examined in the domains of individual abilities and attributes, relationships and significant life activities both pre- and post-assault. Data on pre-assault risk, resilience and function can be used to estimate a “but for the assault” developmental trajectory that can then be compared to the individual’s actual developmental trajectory. This analysis, together with analysis of the severity of CSA, can assist in determining whether and how the CSA that is the basis for civil proceedings contributed to later life psychological injuries.     

What can we learn from the first community-based epidemiological study on stalking in Germany?

There is a lack of community-based studies on prevalence rates of stalking and the impact of stalking on victims in continental European countries. The authors published the first community-based epidemiological study on stalking in Germany. The purpose of this paper is to discuss possible implications of these epidemiological data for the mental health system, forensic psychiatry and legal regulations in Germany. For these reasons some data of our epidemiological study are outlined and reanalyzed. To examine lifetime and point prevalence rates of stalking, behavioural and psychological consequences for victims and the impact of stalking on current psychological well-being in a German community sample, a postal survey was conducted with 2000 inhabitants randomly selected from Mannheim (response rate 34.2%, n=679). The survey included a stalking questionnaire and the WHO-5 well-being scale. Almost 12% of the respondents reported having been stalked. This study identified a high lifetime prevalence of stalking in the community. Effects on victims' psychological health were significant and there was a high rate of physical (31%) and sexual (19%) violence in the context of stalking. Our data suggest that the phenomenon deserves more attention in future forensic psychiatric research and practice. Implications for forensic psychiatric assessment and treatment of stalkers as well as for management of stalking victims are discussed.     

Erratum to: Trends in Psychological/Psychiatric Injury and Law: Continuing Education, Practice Comments, Recommendations

This literature review of the major topics in the field of psychological/psychiatric injury and law is aimed at developing practice in the area. The field is a fast-developing one, with over ten major topics that it needs to integrate. In particular, the present review focuses on current work on: law (evidence, tort); forensic psychology; assessment and testing; psychological injuries (posttraumatic stress disorder, chronic pain, traumatic brain injury, other); the APA DSM-5 draft (Diagnostic and statistical manual of mental disorders; American Psychiatric Association 2010); malingering; causality; multicultural considerations; disability; the American Medical Association (AMA) Guides to the evaluation of permanent impairment (Rondinelli et al. 2008); models; and treatment. At the end of each section of the article, practice comments introduce critical issues in applying the research to psychological work in the area. Whether undertaking tort evaluations, disability, and treatment plan assessments or treating individuals with psychological injuries, the professional needs state-of-the-art information in all the areas listed in order to remain scientifically informed, comprehensive, and impartial. The article concludes with recommendations for an integrated field in psychological/psychiatric injury and law, study in the field, research in its major areas, best practice policies, for example in assessment and treatment, and model building.     

Pain-Related Symptom Reporting Among Hispanics: Implications for Forensic Psychological Evaluations

Competent forensic psychologists constantly pursue the understanding of cultural differences. The purposes of this paper were to describe and explain the literature regarding the influences of the Hispanic culture on reports of pain-related symptoms and disabilities, and to illustrate ways in which culture-specific factors can impact a forensic psychological evaluation that includes malingering identification. The reviewed literature indicates that, as a group, Hispanics do not consistently differ from other ethnic groups on pain-related symptom reports. However, when examining culture-specific indicators, individuals from a Puerto Rican background and those with high acculturation to the American culture tend to report more pain and psychological distress than non-Hispanic Whites and other Hispanic subgroups. Additionally, language barriers and cultural-structured views of health and illness seem to hinder help-seeking options among the Mexican and less-acculturated Hispanics. Based on these results, we discuss a number of recommendations to make forensic psychological evaluations more sensitive to differences in acculturation and country of heritage. By taking these within-culture characteristics into consideration, the forensic psychologist can most accurately comprehend the meanings associated with the Hispanic client’s pain-related experience.     

Trends in Psychological/Psychiatric Injury and Law: Continuing Education, Practice Comments, Recommendations

This literature review of the major topics in the field of psychological/psychiatric injury and law is aimed at developing commentary for practice in the area. The field is a fast-developing one, with over ten major topics that it needs to integrate. In particular, the present review focuses current work on: law (evidence, tort); forensic psychology; assessment and testing; psychological injuries (posttraumatic stress disorder, chronic pain, traumatic brain injury, other); the APA DSM-5 draft (Diagnostic and statistical manual of mental disorders; American Psychiatric Association 2010); malingering; causality; multicultural considerations; disability; the American Medical Association (AMA) Guides to the evaluation of permanent impairment (Rondinelli et al. 2008); models; and treatment. At the end of each section of the article, practice comments introduce critical issues in applying the research to psychological work in the area. Whether undertaking tort evaluations, disability, and treatment plan assessments or treating individuals with psychological injuries, the professional needs state-of-the-art information in all the areas listed in order to remain scientifically informed, comprehensive, and impartial. The article concludes with recommendations for an integrated field in psychological/psychiatric injury and law, study in the field, research in its major areas, best practice policies, for example in assessment and treatment, and model building.     

A Bayesian Item Response Theory Approach to Symptom Validity Detection: Evaluating Psychological Screening Inventory-2 Response Profile Likelihoods

Invalid data in forensic assessment are most often indicated by excessive endorsement of psychiatric symptoms. Although this method of identifying invalid profiles is generally effective, it does not make use of all conditional dependencies in data. Modern psychometric methodologies can be used to identify aberrant response profiles through model-based indices known as person fit statistics. Specifically, the likelihoods of examinees' response profiles can be compared against observed or simulated likelihoods that are derived from empirical models of emotional and psychiatric functioning. This study demonstrates how person fit indices based on item response theory models can be used to detect misfitting response profiles in forensic assessment. Archival data from the Psychological Screening Inventory-2 (R. I. Lanyon, 2010a) were evaluated with Bayesian estimation and posterior predictive model checking to compare the response profile log-likelihoods of 74 forensic participants with 1,046 normative participants. Results suggest 61 % of forensic examinees but only 5 % of normative examinees had misfitting data. Misfitting “fake bad” forensic profiles appeared to be associated with overly discrepant endorsement of symptoms, and misfitting “fake good” forensic profiles appeared to be associated with overly narrow endorsement of symptoms. The high rate of misfit among forensic examinees challenges the appropriateness of basing interpretations of forensic data on reliability and validity coefficients from normative samples. However, because aspects of the methodology are still untested in forensic and clinical assessment (e.g., the use of priors in this study), future research is needed to evaluate its appropriateness for clinical practice.     

A CRITICAL EXAMINATION OF THE SUITABILITY AND LIMITATIONS OF PSYCHOLOGICAL TESTS IN FAMILY COURT

Psychologists are frequently consulted by the courts to provide forensic evaluations in a variety of family court proceedings. As part of their evaluations, psychologists often use psychological tests to assess parents, guardians, and children. These tests can have profound effects on how psychologists arrive at their opinions and are often cited in their reports to the court. However, psychological tests vary substantially in their suitability for these purposes. Most projective tests in particular appear to possess little scientific merit for evaluations within family court proceedings. Despite these serious limitations, expert testimony derived from evaluations using both projective and objective tests is often admitted uncontested. This article reviews the psychometric properties of psychological tests that are widely used in family court proceedings, cautions against their unfettered use, and calls upon attorneys to inform themselves of the limitations of evaluations that incorporate these tests.     

Forensic Assessment of Adults Reporting Childhood Sexualized Assault: Risk,Resilience, and Impacts

Though childhood sexualized assault (CSA) increases risk for varied psychological difficulties, no single condition, syndrome, or set of difficulties is reliably associated with such experiences. CSA likely disrupts or impairs normal development in complex ways that depend on the risk and resilience factors present before, during, and after CSA. CSA characteristics that increase risk for later difficulties include young age, trauma inflicted by another person, number of occurrences, violence or intrusiveness, betrayal of trust, adverse peri-traumatic reactions, negative reactions from others following disclosure, and a context of previous sexualized assault or maltreatment. Resilience increases with positive self-esteem, better intellectual functioning, good self-control, positive social support, and early therapeutic intervention. CSA is associated with impaired psychological development, mental health disorders, behavioural and relationship difficulties, physical health problems, reduced intellectual function, lower educational achievement, lower occupational attainment, and reduced lifetime income. Any particular difficulty may be problematic in its own right and may also contribute to other difficulties in the interlocking domains of individual abilities and attributes, relationships, and significant life activities. In individual forensic assessment cases, general evidence on CSA risk/resilience and impacts can be used in combination with the lifespan developmental analysis (Barnes & Josefowitz, Psychological Injury and Law, 2014), to determine whether and how CSA contributed to psychological injuries.     

THE SCIENTIFIC BASIS OF PSYCHOLOGICAL TESTING

The legal standards for admissibility of expert testimony have recently been raised following several U.S. Supreme Court decisins. Although forensic mental health experts have relied on psychological testing as a method of data collection for many years, the scientific basis of such testing has traditionally gone unquestioned in court. Given the increased scrutiny currently being applied to expert testimony, it is more important now than ever for attorneys, judges and forensic experts to understand the scientific principles underlying psychological tests. In this article, the scientific principles of validity and reliability are explained, and scientifically acceptable methods for the forensic use of psychological testing are discussed. The application of recent case law to several well-known tests is described.