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The Assessment of malingering with the M-FAST. Holly A. Miller, Ph.D. College of Criminal Justice Sam Houston State University. Overview. Malingering Theory and assessment Miller Forensic Assessment of Symptoms Test Development of the M-FAST Utility of the M-FAST - PowerPoint PPT Presentation
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THE ASSESSMENT OF
MALINGERING WITH THE M-
FASTHolly A. Miller, Ph.D.
College of Criminal JusticeSam Houston State University
OVERVIEW Malingering
Theory and assessment Miller Forensic Assessment of Symptoms
TestDevelopment of the M-FASTUtility of the M-FAST
Brief overview of studiesAdministration and scoring of the M-FASTPractice administration InterpretationQuestions
MALINGERING The DSM-IV-TR defines malingering as:
Intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives (APA, 2000)
Why might someone malinger? Prevalence of malingering
Around 8% of general evaluations Around 20% of forensic evaluations
Miller, 2000; Rogers & Cruise, 2000; Rogers, Salekin, Sewell, & Goldstein, 1996
MALINGERING When to assess for malingering Rogers suggests under these
circumstancesAtypical presentation of symptomsUnusually high number of unusual or
obvious symptomsNonselective endorsement of symptomsDiscrepancies between reported and
documented history of mental illness
MALINGERING Why not just use clinical judgment?
DSM criteria Marked discrepancy between reported impairment and
objective findings Lack of cooperation during evaluation or treatment Medico-legal context presentation Presence of APD
What research reports on accuracy of clinical judgment Utilizing DSM criteria results in high false-positive rates Studies strongly support that objective assessment
instruments are significantly more accurate than clinical judgment (Miller, 2005; Rogers 1984; Ziskin, 1984)
MALINGERING Miller, H. A. (2005). The Miller-Forensic
Assessment of Symptoms Test (M-FAST): Test generalizability and utility across race, literacy, and clinical opinion. Criminal Justice & Behavior, 32 (6), 591-611.Study 1 – initial M-FAST items (79 items)
280 forensic patients; 5 psychiatrists; 8 psychologists
M-FAST; SIRS; Mtest; MMPI-2Study 2 – final M-FAST (25 items)
50 forensic patients; 5 psychiatrists; 8 psychologists
M-FAST; SIRS; Mtest; MMPI-2
MALINGERING Study 1 Clinical opinion v. M-FAST
results Psychiatrist Opinion
AUC = .72 (SE = .05)CI = .62 - .8119 FP; 17 FN
Psychologist Opinion AUC = .80 (SE = .04)CI = .72 - .8815 FP; 11 FN
M-FAST (79 items)AUC = .89 (SE = .02)CI = .85 - .93
ROC Curve
Diagonal segments are produced by ties.
1 - Specificity
1.00.75.50.250.00
Sen
sitiv
ity
1.00
.75
.50
.25
0.00
ROC Curve
Diagonal segments are produced by ties.
1 - Specificity
1.00.75.50.250.00
Sen
sitiv
ity
1.00
.75
.50
.25
0.00
ROC Curve
Diagonal segments are produced by ties.
1 - Specificity
1.00.75.50.250.00
Sen
sitiv
ity
1.00
.75
.50
.25
0.00
MALINGERING Study 2 Clinical opinion v. M-FAST results Psychiatrists
AUC = .65 (SE = .09) CI = .47 - .83 7 FP; 7 FN
Psychologists AUC = .73 (SE = .08) CI = .57 - .89 9 FP; 4 FN
M-FAST (final version) AUC = .95 (SE = .03) CI = .88 – 1.00 6 FP; 1 FN
ROC - Psychiatrists
1.00 .75 .50 .25 0.00
1.00
.75
.50
.25
0.00
ROC - Psychologists
1.00 .75 .50 .25 0.00
1.00
.75
.50
.25
0.00
ROC – M-FAST
1.00
.75 .50 .25 0.00
1.00
.75
.50
.25
0.00
MALINGERING How to catch a malingerer
Previous research has indicated important areas of assessment: Certain response styles Certain interview strategies
Several instruments include assessment of response styles or were specifically designed to assess malingering MMPI-2 PAI SIRS
However, there remains a need for a brief screen for malingered mental illness
DEVELOPMENT OF THE M-FAST M-FAST items were developed to
operationalize the response styles and interview strategies that have been validated for identifying individuals who are malingeringReported vs Observed symptoms (RO)Extreme Symptomatology (ES)Rare Combinations (RC)Unusual Hallucinations (UH)Unusual Symptom Course (USC)Negative Image (NI)Suggestibility (S)
DEVELOPMENT OF THE M-FAST M-FAST is a structured interview of 25
items representing the “proven” detection strategies
Administration is approximately 5-10 minutes
Scoring is approximately 10 minutes Does not require the ability to read
(examinee) Has been translated into Korean and
Spanish M-FAST was developed using both known-
group and simulation studies
ADMINISTRATION AND SCORING Materials include manual and 8-page
interview booklet Validated on people 18 yrs and older Validated with different ethnic/race groups Validated across gender Validated with varied populations
In prison On probation In forensic hospital In civil hospital Outpatient disability assessment
ADMINISTRATION AND SCORING Appropriate populations and limitations
Malingered psychopathology (not neuro)Examinee must be able to understand items Adults 18 yrs or olderScreening instrument and was not
developed to be the sole determinate of malingered mental illness
Professional requirements Mental health clinician with formal training
in diagnostic interviewing and assessment
ADMINISTRATION AND SCORING M-FAST should be preceded by a clinical
interviewTo gather both symptom information and
observable behavior (RO assessment help) Read aloud instructions for administration
to client Suggestibility item
1st response dictates how you ask last part of item
Read items and possible responses of each item
May repeat once – but offer no explanation
ADMINISTER M-FAST With partner, practice administration Partner role play a malingerer
Want to appear mentally ill, without elevating M-FAST score
Then reverse roles
ADMINISTRATION AND SCORING Scoring instructions provided on last
page of interview booklet Score individual items Score scales If more than 2 items missing, not
considered valid administration
INTERPRETATION Malingering is distinct from most forms
of psychopathology; however the presence of malingering does not rule out a psychiatric disorder
Significant consequences for malingering diagnosis
Choosing of a cut score for M-FASTMore acceptable to have false positives
than false negativesCut score of 6 utilized
INTERPRETATION Three levels
Total scale Provides an estimate of the likelihood that the examinee
is malingering Interpretive statement: The examinee’s total score on
the M-FAST was significantly elevated, indicating that this individual may be malingering mental illness.
Scales Provides information on how the individual is malingering Can make interpretive statements about scale
elevations, but utilize total score for overall assessment Each scale has own “cut score” Suggestibility item (scale) Manual provides interpretative statement examples
Items
INTERPRETATION Next step
Further malingering assessment is warranted if client elevated M-FAST
M-FAST ARTICLES BY TOPIC Competency to stand trial – forensic
inpatients Jackson, R., Rogers, R., Sewell, K. W. (2005). Forensic
applications of the M-FAST: Screening for feigned disorders in competency to stand trial evaluations. Law and Human Behavior, 29(2), 199-210.
Vitacco, M. J., Rogers, R., Gabel, J., Munizza, J. (2007). An evaluation of malingering screens with competency to stand trial patients: A known-groups comparison. Law and Human Behavior, 31(3), 249-260.
Miller, H. A. (2004). Examining the use of the M-FAST with criminal defendants incompetent to stand trial. International Journal of Offender Therapy and Comparative Criminology, 48(3), 268-280.
M-FAST ARTICLES BY TOPIC Validity Studies
Vitacco, M. J., Jackson, R. L., Rogers, R., Neumann, C. S., Miller, H. A. Gabel, J. (2008). Detection strategies for malingering with the M-FAST: A confirmatory factor analysis of its underlying dimensions. Assessment, 15(1), 97-103.
Miller, H. A. (2005). The Miller Forensic Assessment of Symptoms Test (M-FAST): Test generalizability and utility across race, literacy, and clinical opinion. Criminal Justice and Behavior, 32(6), 591-611.
Veazey, C. H., Hays, J. R., Wagner, A. L., & Miller, H. A. (2005). Validity of the Miller Forensic Assessment of Symptoms Test in psychiatric inpatients. Psychological Reports, 96(3), 771-774.
Guy, L. S., & Miller, H. A. (2004). Screening for malingered psychopathology in a correctional setting: Utility of the Miller Forensic Assessment of Symptoms Test (M-FAST). Criminal Justice and Behavior, 31(6), 695-716.
M-FAST ARTICLES BY TOPIC Civil forensic settings
Alwes, Y. R., Clark, J. A., Berry, T. R., Granacher, R. P. (2008). Screening for feigning in a civil forensic setting. Journal of Clinical and Experimental Neuropsychology, 30(2), 1-8.
M-FAST ARTICLES BY TOPIC Diagnostic-specific malingering assessment
Messer, J. M., & Fremouw, W. J. (2007). Detecting malingered posttraumatic stress disorder using Morel Emotional Numbing Test-Revised and the Miller Forensic Assessment of Symptoms Test (M-FAST). Journal of Forensic Psychology Practice, 7(3), 33-57.
Guriel-Tennant, J., & Fremouw, W. J. (2006). Impact of trauma history and coaching on malingering of posttraumatic stress disorder using the PAI, TSI, and M-FAST. Journal of Forensic Psychiatry & Psychology, 17(4), 577-592.
Guy, L. S., Kwartner, P. P., & Miller, H. A. (2006). Investigating the M-FAST: Psychometric properties and utility to detect diagnostic specific malingering. Behavioral Sciences & the Law, 24(5), 687-702.
Guriel, J., Yanez, T., Fremouw, W. J., Shreve-Neiger, A., Ware, L., Filcheck, H., & Farr, C. (2004). Impact on coaching on malingered posttraumatic stress symptoms on the M-FAST and TSI. Journal of Forensic Psychology Practice, 4(2), 37-56.
THANK YOU!
Holly A. Miller, Ph.D.Assistant Dean of Undergraduate Programs
Associate ProfessorCollege of Criminal Justice
Sam Houston State UniversityHuntsville, Texas 77341-2296
936-294-1686; [email protected]