Psychological testing was developed to examine the cognitive and behavioral aspects of a patient. A variety of tests have been created to evaluate the individual to determine either the diagnosis of the individual or simply to attain an assessment or evaluation of the individual. Each test discussed below can provide advantages to the forensic setting. The validity and reliability of these tests have been extensively evaluated and are discussed.
1. Mental Status Exam
The Mental Status Exam (“MSE”) is used to evaluate a patient’s mental functions and behaviors. The MSE was created as a tool for clinical psychologists to evalute and access the condition of a patient. The exam provides the examiner with information to allow for a proper diagnosis and assessment of the patient’s mental health. A mental health exam is often requested by the court or attorney’s in order to understand the behavior of a defendant. The test is performed by interview of the patient and is used as a way to determine the cognitive ability of an individual. The clinician observes and describes a variety of aspects of the patient as the interview is being conducted. The components of the exam include appearance, behavior, speech, mood, affect, thought process, thought content, cognition and insight or judgment. During the interview the evaluator accesses each component based on that moment in time. However, along with the answers provided by the patient, the examiner must have knowledge of the patient’s background in order to obtain accurate results.
This Mental Status Exam has been updated by various other examinations and also is offered in a shortened version called the Mini Mental Status Examination. The Mini Mental Status Exam is a ten-minute examination and tests the patient’s orientation, memory, concentration, math abilities as well as language and praxis. The Mental Status Exam can result in subjective results as the testers own experience and background could potentially influence the results. The exam also has been inadequate in identifying mild cognitive impairment in patients and those patients with neurologic lesions. Thus, for diagnosing dementia and delirium, the MSE should not be used as the only basis for the diagnosis.
The Mini Mental Status Exam has been used and evaluated more thoroughly through studies to determine its validity. In these studies, there were measures of validity that were on the high scale. However, score results have been found to be affected by the background, age and gender of an individual. These results are also likely to reflect similarity in the MSE. It should be noted that scores have been determined to not be effected by gender.
One particular aspect of the Mental Status Exam measures sensorium. The sensorium is the sensory apparatus associated with an individual’s mental faculties. The measurement approximates consciousness. A sensorium that is not clear presents as an inaccurate memory and inability to orient to time or place. Sensorium is best determined by the use of the Mini Mental Status Exam. Questions presented in the interview to determine sensorium include asking the current time, date and location.
2. Substance Abuse
The CAGE Questionnaire is used to screen a patient for alcoholism. It consists of four questions relating to [C]utting down, [A]nnoyance by criticism, [G]uilty feeling and [E]ye-openers. The questions are presented to the patient as “Have you ever”. For cutting down, the questions ask if the individual ever felt the need to cut down on his or her drinking. For annoyance by criticism, the question is asking the patient if he or she has ever felt annoyed by criticism about his or her drinking. The guilty feeling questions asks whether the individual has had guilty feelings about his or her drinking. And, the eye opener questions ask the patient if he or she has ever had a morning eye opener. These questions are simple and can be provided to a patient in order to detect whether alcoholism is a problem he or she is facing.
The CAGE questionnaire was created by Ewing and Rouse in 1970. It was created by psychologists who were both clinicians and researchers. The questionnaire was initially designed as a screening tool and it has since been supplemented by other tests, like the Michigan Alcohol Screening Tool and the Alcohol Use Disorders Identification Test, that are provide a more detailed analysis of the client’s situation.
The CAGE questionnaire has shown high reliability between test and retest as well as absolute correlations. Study results have revealed that the questionnaire is a valid device to determine alcohol abuse or dependence in patients who are inpatient, medical or psychiatric institutions. However, for white and prenatal women as well college students, the validity is questionable. The questionnaire is also not sufficient to detect misuse of substances. There are, however, alternative tests for this.
3. IQ/Cognitive Functioning
Kaufman Brief Intelligence Test, 2nd ed. (KBIT-2) is a test used to measure an individual’s verbal and non-verbal intelligence . Originally, the test was created to evaluate children to determine if they were in need of assistance in education or work. Additionally, the test was used to measure intelligence in a shortened test. In a forensic setting, this test is typically used to determine the intelligence of an individual. However, this test is often used to determine whether a child should be placed in an educational gifted program but may be administered to individuals ages four to ninety. KBIT-2 takes approximately fifteen thirty minutes too complete. Thus, it is used as a quick measure to determine the intellectual abilities of an individual. The KBIT-2 was created following the KBIT. KBIT-2 can be used to measure intelligence, both verbal and nonverbal, of individuals from age four to ninety. The test has a Vocabulary and a Matrices subset.
KBIT-2 was standardized using over two thousand random sampling of children. The coefficient existing between the various age groups was between .80 and .90. The test reflects concurrent validity and displays significant correlation coefficients. However, researchers recommend that the test be used only for an estimate of general intelligence. KBIT-2 provides a more accurate assessment of changed in intelligence that occurs between adolescence and adulthood.
4. Projective Personality
There has been significant dispute over the validity of the Rorschach Inkblot test as well as considerable variation in the methodology and variation of the technique. The Rorschach Inkblot is a projective psychological test that uses ten inkblot cards. The test taker responds verbally to the cards that present various images. The test was created in 1921 by Hermann Rorschach. He had originally forty inkblot cards but had only used fifteen most often. Once Rorschach could find a publishing for his cards, he was forced to use only ten so he adjusted accordingly . Using scores, results were recorded as to whether the individual’s response pertained to the entire blot, a large protion or a small portion of the blot. Five systems of scoring were created for the responses years after the death of Rorschach. Bruno Klopfer and John Exner contributed to further developments with the test. The test was initially developed to provide a profile of individuals with schizophrenial, however, the test became popular for its use as a projective measure of peronality. In the forensic setting, the test is very common for use to diagnose pychosis in individuals who are less likley to admint psycholgocial issues.
The Rorschach test, although controversial, has presented as a reliable instrument so long as the individual who is presenting the test is experienced. In comparison to other similar tests, the Rorschach test has similar validity scores, which have typicallly ranged from .40 tp .50. There has been test and retest reliability. The reliabilty range has been measured between 85% to 99%.
5. Objective Personality
The Personality Assessment Inventory (PAI) is a self-report questionnaire that measures abnormal personality traits in an individual. The test screens for psychopathology and its results provide information to make a clinical diagnosis and a treatment plan and takes approximately forty to fifty minutes too complete. The applicable population for the PAI is people’s age eighteen and over. The test was created to provide an alternative to the lengthy MMPI. The PAI has 344 items as well as 22 scales. There are four validity scales, eleven clinical scales and five treatment scales. The validity scales contained in the inventory allow the clinician to determine if the test taker distorted his or her answers. Through the use of these scales, improper completion of questions, difficulty in reading, the presence of confusion, exaggeration, as well as defensiveness and malingering can be identified. Consistent response can also be measured.
The clinical scales include somatic grievances, anxiety, anxiety linked disorders, depression, mania, paranoia, schizophrenia, borderline characteristics, antisocial characteristics, alcohol and drug problems. The treatment scales include aggression, suicidal ideation, stress, nonsupport, and rejection of treatment. The scales do not overlap. Norms were established with three samples of 1,000 adults varying in age, race and gender including both clinical patients and college students. The test incorporates validity scales that measure inconsistency, infrequency, negative impression and positive impression. There are only modest variances according to validity correlations. However, there are questions as to methodological concerning the exploratory factor analysis. The Personality Assessment Inventory could be used in a forensic setting to determine the psychosis of individuals.
6. Competency to Stand Trial
A defendant’s competency to stand trial had not been an issue in American Jurisprudence as nearly all individuals were determined to have the understanding to proceed at trial. However, in 1960, the United States Supreme Court ruled that a defendant must be able to consult with his or her attorney and have a rational understanding of the trial at hand. In response to this ruling, the CAI was developed to measure an individual’s competency to stand trial.
The CAI is an assessment test used to determine an individual’s competency to stand trial. CAI is administered in an hour interview with the individual. The test was first created in 1973 to supplement the existing test, the Competency Screening Test and was originally used to as a device to structure an interview of a defendant. The test looks at thirteen abilities of a defendant’s capability to cope with the process of trial. These include the individual’s appraisal of his or her legal defenses, the individual’s assessment of the quality of his or her attorney, and the individual’s ability to reveal facts about the situation, among others. The instrument was developed using a review of court cases, legal literature as well as experience in the clinical setting as well as in the courtroom. Originally, the CAI was designed to be used in conjunction with the Competency Screening Test, it has developed as a tool for its own use a screening device to determine competency.
Research has indicated the accuracy of the CAI is approximately ninety percent. Several other tests have been created since the CAI to measure the competency of an individual to stand trial. The test scoring of the CAI is not standard so no norms exist.
7. Risk Assessment
The Violent Risk Appraisal Guide (VRAG) is an actuarial assessment used to measure the risk of continued violence by an individual who has already engaged in violent behavior. The test was initially created by assessing over six hundred violent offenders. Fifty variables were used to predict recidivism. The scores were obtained from the records of the offenders regarding history, adjustment, offense and assessment results. There was a high degree of accuracy in the prediction of recidivism with this test. The assessment was originally created for male offenders and subsequent studies have revealed a higher level of accuracy of results for males than for females. The original version of the VRAG was created in Canada but is now used worldwide.
The VRAG has been shown to accurately predict misconduct during incarceration for male inmates as well. One issue that has been widely noted is that the VRAG is not an accurate or reliable assessment of female violence prediction. The base rate in all studies has been low. Thus, use of the VRAG for female inmates to obtain a recidivism rate is not recommended. Even though a few risk factors for violence are gender neutral, factors developed on male inmates cannot possibly predict the risk for females.
There has been recorded a high accuracy of prediction of recidivism with the use VRAG. The VRAG has been revised in a version entitled VRAG-R, and another guide similar guide used is the Sex Offender Risk Appraisal Guide which evaluates the recidivism likelihood of sex offenders.
8. Insanity/Criminal Responsibility
The determination of insanity in a criminal defendant has relied on the results of the Rogers Criminal Responsibility Assessment Scales (R-CRAS). The assessment provides clinicians with the ability to formally measure a defendant’s insanity. The R-CRAS is a test used by the criminal court system to determine the insanity of a defendant. The R-CRAS was created by forensic specialists who agreed on the variables that are necessary to validate insanity. The test uses gradations of severity to standardize the evaluation of clinical information . As an assessment, the psychologist designates a number for the individual on a scale of zero to six. An individual with a higher number displays more factors. Behavioral control and psychopathology are two of the factors. The reliability of R-CRAS is very high with high coefficients. And, the malingering rate was modest. As for validity, the samples showed concordance rates that were high.
The R-CRAS was initially created to address the insanity standard that must be assessed to determine a defendant’s impairment at the time he or she committed the charged offense. Three of the scales used include the patient reliability scale, the organicity scale and the psychiatric disorders scale. To determine the legal impairment of the defendant, a cognitive control and behavioral control scales are utilized.
Conclusion
The Mental Health Exam is beneficial in the forensic setting to determine an individual’s current mental condition. Substance Abuse tests, like the CAGE Questionnaire, is useful to determine if an individual will need to undergo treatment for alcoholism. An IQ or Cognitive Functioning psychological test such as the Kaufman Brief Intelligence Test, 2nd edition, is frequently used to determine intelligence in children. However, the test may also be used to evaluate deficiencies in an individual who needs to undergo treatment or rehabilitation. The Rorschach Inkblot test is a Projective Personality test that has been used for many years. Although its adequacy has been questioned, it still can be used to determine the presence of a psychotic disorder in an individual. An Objective Personality test like the Personality Assessment Inventory can be utilized also to determine the existence of a personality disorder in an individual. The more specific types of forensic setting testing include the test to determine competency to stand trial, the test to determine the risk of future violence of an offender and the test to determine the level insanity of an individual in order to participate in trial. The Rogers Criminal Assessment Scales is a formal measure used to determine sanity. The Violent Risk Appraisal Guide is used to determine if an offender will have a tendency to repeat offending. And, the Competency Assessment Inventory measures the understanding of an individual has of the trial process in order to stand trial.
References
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