Metaanalysis debunks psychopathy-violence link

No clear winner among violence risk tools

If you are looking for the best tool to assess someone's risk for violence, the array may seem confusing. Lots of acronyms, lots of statistical data about AUC's (Areas Under the Curve) and the like. What do do?

No worries. As it turns out, they're pretty much interchangeable. That is the bottom-line finding of a groundbreaking metaanalytic study in the APA journal Psychological Bulletin by three academic researchers from the United Kingdom.

The University of Nottingham researchers used sophisticated statistical tools to meta-analyze multiple studies on the accuracy of nine leading violence risk assessment tools. All nine turned out to have similarly moderate predictive accuracy, with none clearly leading the pack. And none -- the scholars warned -- were sufficiently accurate for courts to rely upon them as a primary basis for decision-making in forensic cases requiring "a high level of predictive accuracy, such as preventive detention."

Widely touted PCL-R's "Factor 1" a bust

In a result with potentially momentous implications for forensic practitioners, the researchers found that Factor 1 of the Psychopathy Checklist-Revised (PCL-R) does not predict violence. As you know, Factor 1 purports to measure the core constellation of a psychopathic personality (superficial charm, manipulativeness, lack of empathy, etc.). When introduced in court, evidence of psychopathy has an enormously prejudicial impact on criminal offenders.

But, the PCL-R's much-ballyhooed ability to predict certain types of violence owes only to the instrument's second factor, according to the metaanalysis by researchers Min Yang, Steve Wong, and Jeremy Coid. And that's no surprise. After all, Factor 2 measures the criminogenic factors (criminality, irresponsibility, impulsivity, history of delinquency, etc.) that even a fifth-grader knows are bad signs for a future of law-abiding citizenship.

In my experience, the Factor 1 items -- the ones purporting to measure an underlying personality profile -- are the ones more likely to be inflated by some evaluators. That's because many of these items are pretty subjective. Glib? Superficially charming? If you don't like a guy -- and/or he doesn't like you -- you are more likely to rate these negative items as present. That's one of my hypotheses for the large evaluator differences and partisan allegiance effects found with the PCL-R in forensic practice.

Cumulatively, the emerging PCL-R findings beg the question:

Why introduce the Psychopathy Checklist in court if other violence risk tools work just as well, without the implicitly prejudicial effect of labeling someone as a "psychopath"?

Psychopathy evidence skyrocketing in juvenile cases

Despite (or perhaps because of, in some cases) its prejudicial impact, the construct of psychopathy is increasingly being introduced in court cases involving juveniles. It is often used to infer that a youth should get a longer sentence because he or she is dangerous and not amenable to treatment.

Skyrocketing use of psychopathy evidence in juvenile cases
Source: Viljoen et al, Psychology, Public Policy, and Law (2010)

The first systematic review, published in the current issue of Psychology, Public Policy, and Law, found the use of psychopathy evidence against juveniles skyrocketing in both Canada and the United States. Psychopathy evidence is typically introduced when juveniles are being sentenced as adults and in sex offender commitment cases. It is also introduced in a variety of other cases, including ones involving disputed confessions, competency to stand trial, and criminal responsibility, report authors Jodi Viljoen, Emily MacDougall, Nathalie Gagnon, and Kevin Douglas.

In one egregious case showing how judges may improperly use evidence of psychopathy, a Canadian judge reasoned that a youth's "psychopathic device [sic] score" showed that under his "shy and unassuming" exterior lurked "a monster" that "at any time ... may well come alive." As a result, the judge sentenced this minor to an adult penitentiary.

Such inferences of unremitting danger and untreatability are improper. A large proportion of youths measured high in psychopathy score lower on psychopathy instruments once they mature. And so-called psychopathic youths are far from untreatable; in one recent study by Michael Caldwell and colleagues, after intensive treatment youths who scored high in psychopathy were actually less likely to recidivate than a comparison group in a juvenile jail.

"[T]he introduction of psychopathy evidence into juvenile forensic contexts has been somewhat rushed and premature at times," the authors conclude.

Have risk prediction tools hit the ceiling?

Researchers have been toiling for almost five decades to perfect risk prediction tools. Unfortunately, they keep running into an insurmountable obstacle: A large proportion of violence is situational. It's affected by environmental context, not just qualities internal to the individual. And not only that, but it is always extremely hard to predict a rare event.

Based on their metaanalytic findings, the UK researchers say maybe it's time to stop searching for the holy grail. Maybe we've reached the ceiling of predictive efficacy.

Violent behavior is the result of the individual interacting with the immediate environment. Although it may be possible to improve on our understanding and predicting what an individual may do in hypothetical situations, it will be much more difficult to predict the situation that an individual actually encounters in the open community. Even predicting violence within an institutional environment is difficult, where the assessor has much more information about that environment.

Instead, they say, it is time to turn our attentions to interventions that can reduce risk:

Building a better model of violence prediction should not be the sole aim of risk prediction research, which is just one link in the risk assessment-prediction-management triad that aims to achieve violence reduction and improved mental health…The risk, need and responsivity principles derived from the theory of the psychology of criminal conduct provide a useful theoretical framework for risk reduction intervention. Appropriate risk assessment can identify high-risk individuals in need of more intensive management and intervention…. Using tools with dynamic risk predictors to assess risk can identify appropriate changeable treatment targets linked to violence.

The studies included in the metaanalysis were from six countries: the United Kingdom (11), Canada (9), Sweden (3), the United States (3), Holland (2), and Germany (1). The instruments included the PCL-R, the PCL:SV, the HCR-20, the VRAG, the OGRS, the RM2000V, the LSI/LSI-R, the GSIR, and the VRS, as well as seven instrument ubscales: PCL-R Factor 1 and Factor 2, the 10-item Historical subscale, the five-item Clinical subscale, and the five-item Risk Management subscale of the HCR-20; and the Static and Dynamic scales of the VRS.

Dr. Wong, former Research Director at the Regional Psychiatric Centre in Saskatoon, Saskatchewan, studied psychopathy and high-risk offenders for 25 years and developed the Violent Risk Scale and the Violence Risk Scale-sexual offender version before becoming a special professor at the Institute of Mental Health at the University of Nottingham. Dr. Yang is a professor of medical statistics with the Faculty of Medicine and Health Sciences at the University of Nottingham. And Dr. Coid, Director of the Forensic Psychiatry Research Unit, is principal investigator of the UK Home Office’s Prisoner Cohort Study and also studies the epidemiology of violent and criminal behavior at the population level.

The articles reported on here are:

• Yang, M., Wong, S.C.P., & Coid, J. (2010). The efficacy of violence prediction: A metaanalytic comparison of nine risk assessment tools. Psychological Bulletin, 136, 740-767. Correspondence to: Min Yang.
  

• Viljoen, J.L., MacDougall, E.A.M., Gagnon, N.C., & Douglas, K.S. (2010). Psychopathy evidence in legal proceedings involving adolescent offenders. Psychology, Public Policy, and Law, 16, 254-283. Correspondence to: Jodi Viljoen.
  

Of related interest:

• Boccaccini, M.T., Turner, D.B., & Murrie, D.C. (2008). Do some evaluators report consistently higher or lower PCL-R scores than others? Findings from a statewide sample of Sexually Violent Predator evaluations. Psychology, Public Policy, and Law, 14, 262-283. Correspondence to: Marcus Boccaccini.
  

• Murrie, D.C., Boccaccini, M.T., Johnson, J.T., & Janke, C. (2008). Does interrater (dis)agreement on Psychopathy Checklist scores in Sexually Violent Predator trials suggest partisan allegiance in forensic evaluations? Law & Human Behavior, 32, 352-362. Correspondence to: Marcus Boccaccini.

Open access to schizophrenia articles

Due to the widespread attention it is getting, a special issue of Current Directions in Psychological Science on schizophrenia has just been made freely accessible online, the Association for Psychological Science announced. The articles (available HERE) include:

• Neurodevelopment and Schizophrenia: Broadening the Focus by Elaine Walker, Dan Shapiro, Michelle Esterberg, and Hanan Trotman

• Prenatal Factors in Schizophrenia by Suzanne King, Annie St-Hilaire, and David Heidkamp

• Current Research on the Genetic Contributors to Schizophrenia by Michael F. Pogue-Geile, and Jessica L.Yokley

• Schizophrenia Course, Long-Term Outcome, Recovery, and Prognosis by Thomas H. Jobe and Martin Harrow

• Structural and Functional Brain Abnormalities in Schizophrenia by Katherine H. Karlsgodt, Daqiang Sun, and Tyrone D. Cannon

• Ventral Hippocampus, Interneurons, and Schizophrenia: A New Understanding of the Pathophysiology of Schizophrenia and Its Implications for Treatment and Prevention by Anthony A. Grace

• Social Factors in Schizophrenia by Jill M. Hooley

• Social Cognition in Schizophrenia by Michael F. Green and William P. Horan

• Cognitive Functioning and Disability in Schizophrenia by Philip D. Harvey

• Emotion in Schizophrenia: Where Feeling Meets Thinking by Ann M. Kring and Janelle M. Caponigro

• Psychosocial Treatments for Schizophrenia by Jean Addington, Danijela Piskulic, and Catherine Marshall

• New Opportunities in the Treatment of Cognitive Impairments Associated with Schizophrenia by Mark A. Geyer

Get 'em while they're fresh!

Hat tip: Ken Pope

Forensic psychology at the crossroads

Leading forensic psychologist calls for reform

Alas, summer is over. For my fall forensic overview course, I just read Kirk Heilbrun's new article in Psychology, Public Policy, and Law on the future of forensic psychology. He frames it in the context of the National Science Foundation's scathing report on problems with scientific accuracy and bias in other forensic science disciplines.

Psychology's progress in the forensic arena is at least as good as those of the hard sciences such as chemistry and biology, say Heilbrun and co-author Stephanie Brooks, also of Drexel University. The field has come a long way in the last three decades: Texts and journals galore, about three dozen forensically oriented doctoral programs, many doctoral internship sites with a significant forensic component, various sets of practice guidelines, and even a "best practices" series by Oxford University Press.

But we could do better, says Heilbrun, a pillar of the forensic psychology community.

The limited research on field practices finds three levels of competence:

• Best practice: Forensic psychologists practicing at the aspirational level expected from highly trained and experienced specialists

• Appropriate practice: Forensic psychologists who practice in a manner consistent with relevant standards and guidelines set by the field

• Poor practice: Forensic psychologists whose work is so deficient that it is inaccurate, irrelevant, and/or not helpful to the courts.

Unfortunately, as many of us can attest, there is plenty of this poor-quality work, which can not only harm the individuals in the legal system but also damage our field's reputation. Common problems found with poor forensic reports include extreme brevity, an inadequate data base, use of outdated or irrelevant tests, substantial errors in test scoring or interpretation, and failure to grasp the relevant legal constructs.

Recommendations for improvement

In making recommendations to improve forensic psychology practice, Heilbrun and Brooks focus on the areas identified by the National Science Foundation study (which did not include the fields of psychiatry or psychology). These include both the quality of the underlying science and the elements of bias and human error. They recommend exploring the possibility of adding forensic psychology within the proposed National Institute of Forensic Science as one method of improving quality control. Other recommendations:

• Develop quantifiable measures of reliability and accuracy of forensic analyses.

• Competitively fund peer-reviewed research on the scientific bases of validity of forensic methods.

• Develop quality improvement procedures to ensure best practice and minimize error.

• Continue cutting-edge research on observer bias and human error in forensic examinations, like the work of Dan Murrie, Marcus Boccaccini, and colleagues on partisan allegiance.

Striking lack of diversity

Finally, Heilbrun and Brooks make a strong plea for greater attention to our field's lack of ethnic and cultural diversity, lest forensic psychology become irrelevant by the mid-21st century:

One of the striking gaps in forensic psychology is between those who provide services and those who are assessed and treated, and about whom legal decisions are made, in consideration of these services. It is crucial that this gap be narrowed. The racial and ethnic composition of the United States is changing; by 2040, it is estimated that Latina/Latino citizens will be in the majority. The delivery of services, and the research on their effectiveness, by individuals with a high degree of specific cultural competence is likely to be promoted by increasing the number of forensically trained psychologists of African American, Asian American, Latina/Latino, American Indian, Alaska Native, Native Hawaiian, and multiracial backgrounds providing such services.

Addressing this goal will require actively encouraging, even recruiting, minority individuals as early as high school. Minority issues within APA are promoted in part through a multigroup council. One potentially effective strategy for the field of forensic psychology would involve closer collaboration with councils like this and with secondary schools and colleges that educate substantial proportions of minority students. The effectiveness of this diversity effort will have a major impact on the extent to which forensic psychology is perceived as providing services that are culturally competent and effective—and the extent to which it actually provides such services.

The article is: Heilbrun, K., & Brooks, S. (2010). Forensic psychology and forensic science: A proposed agenda for the next decade. Psychology, Public Policy, and Law 16, 219-253. Correspondence should go to Dr. Heilbrun.

"Islamophobia" prompting rise in hate crimes?

Chinese animation video seen worldwide

You have heard the hoopla over banning a mosque near "Ground Zero" in New York City. And the buzz about the startling level of American ignorance over President Obama's religion (a Pew poll showed about one in five Americans think he is Muslim). Now, a Chinese animated news video links these macro stories with the stabbing of a New York cab driver, making the case for a rise in anti-Muslim violence in the USA. Michael Enright (pictured at right), a film student, allegedly stabbed the cabbie out of anti-Muslim bias. Enright's journals will undoubtedly be used in court as evidence of the biased motivation necessary for a hate crime conviction. Ironically, given his own actions, he allegedly wrote that Muslims were "filthy murderers without a conscience." For a glimpse at international opinion, this 90-second video clip from Next Media Animation in Taiwan is worth checking out:

Related blog post:

Judge may block hater from misusing courts: First Amendment and fair use doctrine at issue (March 8, 2008)

Report: Sexual abuse rampant in U.S. prisons

I will never forget "Sean," a young man I treated in prison. When he first arrived after a minor theft conviction, the 19-year-old was assigned a cell with an older convict who saw him as fresh meat. When Sean reported being raped, he was moved to a segregation housing unit for safety. Solitary housing was like torture for this active young man. After months without stimulation, he tried to hang himself. He was punished by being transferred to a harsher prison.

Sean came to mind when I saw the report released today from the Bureau of Justice Statistics (BJS) reporting epidemic levels of sexual abuse of prisoners across the United States. At least 88,500 prison and jail inmates were abused last year, many repeatedly. Several facts in the report, mandatory under the Prison Rape Elimination Act of 2003, are worth highlighting:

• Guards commit much of the abuse
• Women prisoners are more at risk from other prisoners, while men are most at risk from guards
• Gay, transgender, and effeminate prisoners are at heightened risk, as are prisoners with histories of sexual abuse
• Much of the abuse happens on the first day
  

Graphics credit: Just Detention International

The news comes as no surprise to the folks at Just Detention International, an organization dedicated to ending sexual abuse behind bars. They receive dozens of letters a week from prisoners who are being sexually abused.

• William in Texas wrote that he would misbehave to get locked in the hole just to get away from the guard who was sexually abusing him. He has tried to kill himself, and fears telling his longtime girlfriend.

• James, a gay prisoner in Michigan, has been raped more than 20 times by numerous prisoners. "Do you know what it's like to see their faces each day? Seeing the look they give me? Knowing that they smile and laugh,” he wrote.

A call for research and action by psychology

Just ahead of the report's release, two psychologists published an article in Psychology, Public Policy, and Law calling for more attention to the problem. "To date, psychology has been largely silent on the issue of prison rape," wrote Tess Neal and Carl Clements of the University of Alabama.

In their article, "Prison Rape and Psychological Sequelae: A Call for Research," Neal and Clements call for research into the "rape subculture" that makes sexual victimization more prevalent in American prisons than elsewhere in the world:

It appears that prison rape in the United States is a much more serious problem than it is in other countries. This fact calls for comparative analysis of systems to look for correlates of victimization rates. What is it about the U.S. prison system that exacerbates the problem of prison rape? Some would argue that inordinately high incarceration rates, and policies that capture more persons with mental disorders is part of the systemic problem. Can these conditions be reversed?

They go on to discuss the "serious and long-lasting" effects of prison rape, "with potentially devastating physiological, social, and psychological components":

Many rapes are violent, bloody, and physically traumatic to victims. Gang rapes are often characterized by extreme abuse and may be particularly traumatic. In addition, the threat and reality of contracting HIV/AIDS has added a new dimension of physical and psychological terror for victims. Loss of social status in the prison facility, labeling, stigmatization, and further victimization are other potential consequences for victims…. The postrape symptoms of prison rape survivors may be even more complex and pervasive than those of other types of sexual assaults based on the fact that many victims are repeatedly assaulted, experience negative social reactions from the prison community, including many staff, and may be perceived as homosexual. The humiliation and perceived loss of one's masculinity, as well as the extensive victim blaming found in prisons could perpetuate the negative psychological effects, possibly increasing the risk of developing PTSD.

The role of expert witnesses

Under the 1994 U.S. Supreme Court case of Farmer v. Brennan, prison administrations are liable when they practice "deliberate indifference" to prison rape. Neal and Clements discuss how expert psychological testimony may be useful in such civil litigation, the authors explain, both to explain the psychological sequelae experienced by prisoners and to discuss the environments that foster prison rape. Further research is also needed into the legal atmosphere surrounding such litigation, they note:

Courtroom dynamics in these atypical cases (e.g., when a male prison rape survivor is a plaintiff filing suit against prison officials) need to be examined. Public biases should be identified so that they can be countered with informative testimony to dispel them. Investigations using the diagnosis of PTSD in these circumstances should be initiated to learn more about how jurors respond to the traumatic aspects of prison rape victimization. As research uncovers more accurate descriptions of the psychological sequelae of such victimization, researchers should examine how jurors respond to these new descriptions in a courtroom setting

The full report by BJS statisticians Allen J. Beck and Paige M Harrison is HERE; selected highlights and a press release are HERE. Correspondence concerning the Psychology, Public Policy, and Law should go to Tess Neal of the University of Alabama.

Related blog posts:

• Prison pipeline for transgender youth (March 26, 2008)
• Researching prison rape (Aug. 10, 2009)
• Reports of sexual assault in prison implicate guards (Aug. 18, 2007)

Forensic update: Malingering and incompetency

New response style measure hitting the market

Randy Otto and colleagues are as busy as beavers these days. I just blogged about Dr. Otto's new violence risk assessment text; now he and colleagues Jeffrey Musick and Christina Sherrod are releasing the Inventory of Legal Knowledge, a brief measure of response style for defendants undergoing adjudicative competence evaluations.

The 61-item, true-false test is orally administered and takes about 15 minutes. Questions are phrased in simple language and concern the legal process. It's highly portable for in-custody settings. And at $129 for the complete kit it's not a bad deal, considering PAR's normally hefty pricing. (You can order it now, but it won't actually release until mid-September.)

The theoretical basis is the same as for the Test of Memory Malingering and other measures of malingering; one suspects dissimulation when scores are either significantly lower than chance or significantly lower than attained by relevant normative groups.

A validation study has been published online in advance of the print edition of Assessment. The study, by the test authors, is titled: “Convergent validity of a screening measure designed to identify defendants feigning knowledge deficits related to competence to stand trial.” Here is the Abstract:

Because some defendants undergoing evaluation of their competence to stand trial may feign limitations in their ability to understand and participate in the legal process, assessment of their response style is critical. Preliminary research indicates that the Inventory of Legal Knowledge (ILK) has some potential to identify persons feigning competence related impairments. This study examined the convergent validity of the ILK using a sample of criminal defendants who, while undergoing competency evaluations, were administered the ILK and other response style measures. Moderate correlations between the ILK and these other tools provided some support for the ILK as a measure of response style.

More information is HERE.

Online review of updated SIRS malingering test

Richard Rogers' widely utilized Structured Inventory of Reported Symptoms (SIRS) has just been updated with a second edition, and forensic psychologist Steve Rubenzer of Houston, Texas (where "we don't only sing, but we dance just as good as we walk") has a critical review in the Open Access Journal of Forensic Psychology. The abstract:

The Structured Inventory of Reported Symptoms-2 (SIRS-2) contains significant changes designed to prevent false-positive and false-negative classification errors. While the SIRS-2 has many laudatory features, the manual contains some erroneous and questionable statistics and arguments, and authors sometimes stray from the best practices advocated by the first author. The SIRS-2 is a strong choice for assessing feigned psychosis and severe psychopathology. However, evidence for its value in assessing many other conditions, particularly somatic complaints and feigned cognitive impairment, is quite limited.

The full review is online HERE.

Overview: Feigning adjudicative incompetence

And, there's more! Sherif Soliman and Phillip J. Resnick have an overview of accepted methods for detecting feigning in competency evaluations, including specific instruments and their limitations, forthcoming from in an upcoming issue of Behavioral Sciences & the Law that is now online in advance of the print edition. The abstract:

Competence to stand trial (adjudicative competence) is the most requested forensic psychiatric evaluation, with an estimated 60,000 referrals annually. The challenge of detecting feigned incompetence has not been systematically studied until the past decade. Estimates of feigned adjudicative incompetence vary from 8 to 21%. This article reviews techniques for detecting malingered psychosis and malingered cognitive impairment during competence evaluations. Specific techniques for assessing feigned adjudicative incompetence and estimating the malingerer's genuine abilities are discussed. A stepwise approach to suspected feigned adjudicative incompetence is proffered.

Since this manuscript was already in press when the new ILK and the revised SIRS-2 were released, these instruments are not reviewed. In addition to a basic overview of instruments, however, Soliman and Resnick also describe a structured approach. As the authors point out, "Unlike many other evaluations, the assessment of adjudicative competence does not end with the determination that the defendant is malingering." Even with an uncooperative individual, the evaluator must make an effort to determine the subject's genuine capabilities.

Correspondence about that article should go to Dr. Soliman, Senior Clinical Instructor of Psychiatry at Case Western Reserve University in Ohio.