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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

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the assessment of malingering with the m fast

The Assessment of malingering with the M-FAST

Holly A. Miller, Ph.D.

College of Criminal Justice

Sam Houston State University

overview
Overview
  • Malingering
    • Theory and assessment
  • Miller Forensic Assessment of Symptoms Test
    • Development of the M-FAST
    • Utility of the M-FAST
      • Brief overview of studies
    • Administration and scoring of the M-FAST
    • Practice administration
    • Interpretation
    • Questions
malingering
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
malingering1
malingering
  • When to assess for malingering
  • Rogers suggests under these circumstances
    • Atypical presentation of symptoms
    • Unusually high number of unusual or obvious symptoms
    • Nonselective endorsement of symptoms
    • Discrepancies between reported and documented history of mental illness
malingering2
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)
malingering3
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-2
    • Study 2 – final M-FAST (25 items)
      • 50 forensic patients; 5 psychiatrists; 8 psychologists
      • M-FAST; SIRS; Mtest; MMPI-2
malingering4
malingering
  • Study 1 Clinical opinion v. M-FAST results
  • Psychiatrist Opinion
    • AUC = .72 (SE = .05)
    • CI = .62 - .81
    • 19 FP; 17 FN
  • Psychologist Opinion
    • AUC = .80 (SE = .04)
    • CI = .72 - .88
    • 15 FP; 11 FN
  • M-FAST (79 items)
    • AUC = .89 (SE = .02)
    • CI = .85 - .93
malingering5
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
malingering6
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
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 malingering
    • Reported 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 fast1
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
Administration and scoring
  • Materials include manual and 8-page interview booklet
  • Validated on people 18 yrsand 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 scoring1
Administration and scoring
  • Appropriate populations and limitations
    • Malingered psychopathology (not neuro)
    • Examinee must be able to understand items
    • Adults 18 yrsor older
    • Screening 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 scoring2
Administration and scoring
  • M-FAST should be preceded by a clinical interview
    • To 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
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 scoring3
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
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-FAST
    • More acceptable to have false positives than false negatives
    • Cut score of 6 utilized
interpretation1
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
interpretation2
interpretation
  • Next step
    • Further malingering assessment is warranted if client elevated M-FAST
m fast articles by topic
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 topic1
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 topic2
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 topic3
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
Thank you!

Holly A. Miller, Ph.D.

Assistant Dean of Undergraduate Programs

Associate Professor

College of Criminal Justice

Sam Houston State University

Huntsville, Texas 77341-2296

936-294-1686; hmiller@shsu.edu