Mahoney, James J., III; Bender, Scott D.; Arredondo, Beth C.; Marcopulos, Bernice A.
Abstract
The following case report illustrates the value of neuropsychological expertise in disentangling the effects of brain injury and malingering when evaluating competency to stand trial (CST). A 58-year-old Caucasian male, charged with first-degree murder, sustained a self-inflicted gunshot wound to the head, with significant frontal lobe damage. He underwent multiple examinations of CST as well as competency restoration and cognitive remediation attempts. Initial neuropsychological evaluation revealed profound aphasia and neurocognitive dysfunction, with adequate performance validity; however, subsequent exams suggested nonneurological speech changes and symptom exaggeration, with no benefit from education efforts. The defendant was ultimately found competent to stand trial. This case study is a useful example for practicing forensic clinicians, as it involves both unequivocally severe brain injury and unequivocal response bias. It also raises technical and conceptual issues regarding malingering assessment in general and the revision of the Slick criteria for malingering specifically (e.g., the concept of "secondary malingering").
