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Applied Neuropsychology
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Malingering Detection in a Mentally Retarded Forensic

Population
Jill S. Hayes, David B. Hale & William Drew Gouvier

Available online: 07 Jun 2010

To cite this article: Jill S. Hayes, David B. Hale & William Drew Gouvier (1998): Malingering Detection in a Mentally Retarded
Forensic Population, Applied Neuropsychology, 5:1, 33-36

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 Applied Neuropsychology Copynght 1998 by
1998, Vol. 5, NO. 1,33-36 Lawrence Erlbaum Associates, Inc.

BRIEF REPORTS

Malingering Detection in a Mentally Retarded Forensic Population

Jill S. Hayes
Felicia,uz lTorensic Faciliq, Jackson, Louisiana, USA, and Department of Psychiatry
and Behavioral Sciences, Medical University of South Carolina, ~Charleston,
South Carolina, USA
David B. Hale
Feliciana Forensic Facility, Jackson, Louisiana, USA
William Drew Gouvier
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Depart,went of Psychologj~,Louisianu State University, Baton Rouge, Louisiana, [JSA

Thirty-ninepatients in aforensic mental hospital nJereevaluated using the Structured Interview

of Reported Symptoms (SIRS)and several tests used for detecting malingt?redpsychiatric and
neuropsyclzological dysfunction. Patients were initially classified by a mtiltidisciplinary team
as nonmalingering participants (n = 12) and known malingerers ( r ~= 9). All participants in
both groups were pretrial and had beenfound incompete~ttto stand trial by the court. Eighteen
more patients found to be not guilty by reason of insanity by the courts were included in the
study. Using the SIRS alone, 95% overall classification accuracy was obtained. When the
scores on the Dot Counting Test, Memory for Fifteen Items Test, and the M-Test were added
to the discriminantfunction, all patients were correctly classified to the re,spectivegroups. The
results are discussed in terms of complimenting interdisciplinary team di~ignosiswith psycho-
logical testsfor malingering.

Key words: malingering, mental retardation

Evading criminal prosecution is the incentive of the
criminal malingerer (American Psychiatric Associa-
tion, 1994; Rogers, 1988, 1990). Among persons who
successfully feign. it is likely they will achieve the
criminal status of not guilty by reason of insanity
(NGBRI), offering them the prospect of "easy time,"
rather than a guilty verdict. Among persons convicted
of murder, it has been reported some people have only
been hospitalized for 1 day (Pasewark & McGinley,
1985; Pasewark, Pantle, & Steadman, 1979) and were
set free without prolonged hospital confinement or jail
time. Given such a huge incentive, a clinician must be
cognizant of the possibility of malingering and how to
detect it.
Requests for reprints should be sent to W~lliamDrew Gouvier,
LSU Psychology Department, 236 Audubon Hall, Baton Rouge, LA
70803-5501 USA
Many measures have been developed to aid the clini-
cian in ruling out malingering. However, such measures
have been normed on individuals with "normal" intelli-
gence (Lezak, 1995). MLentally retarded criminals have
been virtually ignored in the malingering literature. This
is not surprising,as only recently has dual diagnosis (e.g.,
mental retardation and a mental disorder) been more
widely recognized, and dually diagnosed individuals are
often deprived of treatment services for their comorbid
mental disorder (Matson & Mulick, 1991). Approxi-
mately 16%of murderlinsanity defendants are mentally
retarded (Lanzkron, 1963), and the Supreme Court has
recently ruled that persons with mental retardation are
not constitutionally protected from the death penalty
(Calnen & Blackman, 1992). Therefore, it is important
to examine whether malingering measures can accu-
rately discriminate mentally retarded individuals who
present honestly from those who do not.
 HAYES, HALE, GOUVIER

Method tardation were determined by a treatment team of phy-

Thirty-nine men were drawn from the population of
a state facility for the criminally insane. Twelve par-
ticipants had a pretrial status, were considered not
competent to stand trial by the courts, and were classi-
fied as not malingering following interdisciplinary
team evaluation that included an initial psych~logical,
psychiatric, competency, and social work assessment
that specifically excluded all the measures under study
i.n this investigation. Eighteen patients were found by
the court to be NGBRI and thus had an incentive to
maximize mental health in order to be released. These
participants were included to determine classification
accuracy, not to determine if the measures could suc-
cessfully predict dissimulation (i-e., faking good). Fi-
nally, 9 pretrial patients were classified as documented
malingerers. Diagnoses of malingering and mental re-
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sicians, psychologists, social workers, corrections offi-
cer, and nurses-independent of this study and not using
any of the measures under investigation here-and in-
cluded an examination of school records (when avail-
able), interview data, testing protocols, and behavioral
observations. Each of these 9 participants met stringent
Diagtzostic and Statistical Manual ofMenta1 Disorders
(3rd ed., rev.; American Psychiatric Assoc:iation, 1987)
and Diagrzostic and Statisticczl Manual of Mental Dis-
orders (4th ed.; American Psychiatric Association,
1994) criteria for malingering, and all had been ob-
served engaging in behaviors specifically incompatible
with their stated complaints. All maling~zringpartici-
pants endorsed significant psychiatric complaints; one
endorsed comorbid complaints of memory dysfunc-
tion. Demographic informat~onand primary and co-
morbid diagnostic findings are summarized in Table 1,

Table 1 Demographic Information and Diagnoses of the Sample

Group Membership
Pretrial NGBRI Malingerer

Number of Partzipants 12 18 9
Age
M 28.0 35.0 27.4
SD 7.3 6.5 3.8
Years of Education
M 8.1 8.6 8.9
SD 2.8 2.6 18
XQ
M 61.0 60.2 66 0
SD 5.6 49 63
Substance-Related Disorders 8 (57%) 10 (63%) 4 (44%)
Schizophrenia and Other Psychotic Disorders 5 (36%) 11 (69%) 3 (33%)
Personality Disorders
Antisocial Personality Disorder 2 (14%) 2 (13%) 5 (56%)
Organic Personality Disorder, Explosive Type 0 (0%) 1 (6%) 0 (0%)
Passive Aggressive Personality Disorder 0 (0%) 1 (6%) 0 (0%)
Personality Disorder, Not Otherwise Specified 0 (0%) 1 (6%) 0 (0%)
Borderline Personality Disorder 0 (0%) 0 (0%) 1 (11%)
Schizotypal Personality Disorder 0 (0%) 1 (6%) 0 (0%)
Total 2 (14%) 6 (38%) 6 (67%)
Other Disorders
Adjustment Disorder With Depressed Mood i (7%) 0 (0%) 1 (11%)
Dementia 1 (7%) 0 (0%) 0 (0%)
Organic Brain Syndrome 1 (7%) 1 (6%) 0 (0%)
Depressive Disorder Not Otherwise Specified 0 (0%) 0 (0%) 4 (44%)
Total 3 (21%) 1 (6%) 5 (56%)
Mental Retardation 12 (100%) 18 (100%:~ 9 (100%)
Malingering 0 (0%) 0 (0%) 9 (100%)
Nqte: IQ was determined either by using the S l p l e y Institute of Living Scale to predict Wechsler Adult Intelhgence Scale (WAIS-R) IQ or
the by using the WAIS-R Full Scale IQ. NGBRI = not guilty by reason of insanity
 IDENTIFYING MALINGERERS IN THE MENTALLY RETARDED

Table 2. Arresting Churge classification as a malingerer; and 100% of the pretrial

patients were correctly i'dentified.
Group Membership When the Dot counting Test, the MFIT, and the
preltrial NGBRI Malingerer M-Test were added to the SIRS in the second DFA, the
analysis continued to be significant O)< .001). All cases
Number of Participants 12 18 9 were correctly classified across groups. The third analy-
Murder 6 (43%) 1 (6%) 4 (44%)
sis ornitted the SIRS scores, using only the other tests
Rape 3 (21%) 4 (25%) 1 (1 1%)
3 (19%) 0
as predictor variables. 1Uthough this analysis reached
BatteryIAssauH 1 (7%)
RobberylBurglary 2 (14%) 3 (194) 3 (33%) o~erallsignificance ( p .:.05), only 59.5% of the cases
Drug-Related Crime 2 (14%) 1 (6%) 0 were correctly classified across groilps. A 33.3% mis-
Arson 1 (7%) 4 (2.5%) 0 classification rate occurred in the rnalingering group.
Revocation of Robation 0 1 (6%) 0 Furthermore, 23.1% of pretrial participants and 27.8%
Forgery D 1 (6%) 0 of NGBRI participants were falsely classified as malin-
- gerers.
Note: NGBRI =Not guilty by reason of insanity.
The generalizalility of these finldingsis somewhat
limited by our use of a highly homogeneous participant
and a listing of the arresting charges is presented in sample and a relatively low participant-to-variable ra-
Table 2. tio. Furthermore, researchers should recognize that the
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A consent form that stated they would be under no
risk during testing was given to all participants. The Dot
Counting Test (Lezak, 1995),the M-Test (Beaber, Mar-
ston, Michelli, & Mills, 1985), the Memory for Fifteen
Items Test (MFIT; Davidson, Suffield, Orenczuk, Nan-
tau, & Mandel, 1991; Lezak, 1995), and the Structured
Interview of Reported Symptoms (SIRS; Rogers,
Bagby. & Dickens, 1992; Rogers, Kropp, Bagby, &
Pickens, 1992) were individually administered to every
participant in random order. Tests were given according
to the published instructions,in a quiet room. A debrief-
ing statement was read to the participant after testing.
Results and Discussion
Three separate multiple discriminant function analy-
ses (DFA) were run. The first included just the raw
scores of the SIRS' eight primary scales (cf. Rogers,
Bagby, & Dickens, 1992).This analysis reached overall
significance @ < .OO 1). Some 94.9% of the cases were
correctly classified across groups (see Table 3). Of the
malingerers, 89% were correctly classified, with one
misclassification as an NGBRI patient; 94.4% of the
NGBRI patients were correctly grouped, with one mis-
malingering tests and the interdisciplinary team assess-
ment were largely based on the same self-report of
symptoms and behaviors, which limits incremental va-
lidity to clinical decision making. Still, these tests may
validate initial impressions by the treatment team. In
addition, the robustness of our findings offer encourage-
ment to clinicians who would pursue empirical ap-
proaches to the identificationof malingering in forensic
settings. Replication of these findings in other settings,
using a more heteroge:neous subject pool, is clearly
indicated.
Although the preceding limittitions are acknow-
ledged, these findings are very promising. Using the
SIRS raw scores alone, 95% of the malingerers were
correctly classified. :klisclassification of the one
NGBRI patient as a malingerer has little personal or
societal impact, because this individual had already
been "excused" for his crimes and was not legally guilty.
Furthermore, this patient could actually be a malingerer
who successfully escapedfrontline detection prior to the
court's determination. Concern remains for the one
malingering patient who was misclassified as NGBRI,
as this patient can be expected to exert conscious effort
toward earning his freedom by behaving in such a
manner in order to gain early release from the hospital.

Table 3 Class~jicationResults Usrng the Subtests of the SIRS

LegdClinical Status n Pretrial NGBRI Malingerer

Pretrial Defendant 12 12 (100%) O (0%) 0 (0%)
NGBRI 18 0 (0%) 17 (94.4%) 1 (5.6%)
Malingering Defendant 9 0 (0%) 1 (11.1%) 8 (88.9%)
Note: NGBRI = Not guilty by reason of insanity.
 HAYES, HALE, GOUVIER
The additional three tests do improve the overall
classification rate by 5% to loo%,.Because these tests
take no more than 15 min to complete and do improve
classification accuracy, they provide incremental valid-
ity over that contributed by the SIRS alone. The SIRS
alone and combined with oi;her common tests of malin-
gering accurately discrimir~atesmalingerers in a men-
tally retarded criminal pctpulation and can validate
clinical decisioti making.
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Original submission May 7, I997
Accepted October 7,1997