Faculty Proceedings, Presentations, Speeches and Lectures


Assessing the Validity of Psychiatric Symptoms due to Traumatic Brain Injury

Event Location / Date(s)

Seattle, WA / November 17-20, 2004

Document Type

Conference Proceeding

Presentation Date


Conference Name / Publication Title

24th Annual Meeting of the National Academy of Neuropsychology



Objective: The Miller Forensic Assessment Test is a brief structured interview designed to identify malingered psychiatric symptoms. This study was designed to determine the specificity and sensitivity of the MFAST in criminal litigation involving claims of insanity due to head trauma.

Method: The head injured group consisted of 24 non-litigating patients hospitalized at least 30 days for treatment of primarily moderate and severe trauma. Mean FSIQ was 74.2 (S.D. = 14.2) at 3 years post-injury. The malingering group consisted of 24 persons recruited from a law school, medical school, or public library. Mean FSIQ as estimated by the Weschler Test Adult Reading was 108.5 (S.D. = 11.9). Malingerers were instructed to feign insanity due to head trauma without being detected when interviewed in order to avoid criminal prosecution.

Results: 91.7% of head trauma patients and 71.8% of malingerers were accurately identified using the published MFAST clinical cutoff score. Eighty-three percent of head trauma and 100% of malingerers were correctly classified using the cutoff score recommended for screening purposes. Head trauma patients reported significantly fewer extreme symptoms, rare symptom combinations, unusual symptoms, symptoms discrepant from those observed, and total symptoms than malingerers. MFAST scores were unrelated to FSIQ in head trauma patients, but malingerers with lower FSIQ’s were more likely to be detected.

Conclusions: The MFAST has good diagnostic accuracy in cases that involve insanity due to the psychiatric consequences of traumatic brain injury. Specificity can be maximized by use of the cutoff score derived for clinical groups.

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