Fetal alcohol spectrum disorder and confabulation in psycholegal settings: A beginner's guide for criminal justice, forensic mental health, and legal interviewers.

Fetal alcohol spectrum disorders (FASD) are neurodevelopmental/neurobehavioral conditions caused by prenatal alcohol exposure (PAE). Impairments caused by PAE contribute to the over-representation of individuals with FASD in the United States juvenile and adult criminal justice systems. These same impairments can equally impact on individuals with FASD who are witnesses to or victims of crime who also have to navigate the complexities of the criminal justice system. Difficulties include increased susceptibility to confabulation throughout the legal process that, in turn, can contribute to increased rates of poor outcomes including false confessions and wrongful convictions. Individuals with FASD are particularity at risk of confabulation when they are subjected to tactics, such as stressful and anxiety-provoking situations, threats, and leading, suggestive, or coercive questioning. Many professionals in the forensic context are unfamiliar with FASD or related confabulation risk and may unintentionally utilize tactics that intensify impacts of pre-existing impairment. This article serves as a beginner's guide for professionals working in criminal justice settings by (a) providing research-based overviews of FASD and confabulation, (b) describing how FASD may lead to confabulation, and (c) suggesting ways that professionals can modify protocols when interacting with individuals with FASD. Suggestions in this article hold the potential to decrease the risk of confabulation in the criminal justice system and decrease problematic outcomes, such as false confessions and wrongful convictions among individuals with FASD.

Suggestibility and confabulation among individuals with Fetal Alcohol Spectrum Disorder: A review for criminal justice, forensic mental health, and legal interviewers.

Fetal Alcohol Spectrum Disorders (FASD) are conditions arising from prenatal alcohol exposure which results in a range of neurodevelopmental deficits in areas including cognition, memory, language, executive functioning, emotional regulation, and adaptive functioning. Deficits in various neurodevelopmental areas can range from mild to severe, depending on many factors including the quantity and timing of alcohol exposure during the prenatal development period. During interviews in criminal justice, forensic mental health, and legal contexts (e.g., criminal investigations, cross examination, victim interviews, interviews for lawsuits, forensic evaluations, pre-sentence investigations), deficits associated with FASD may elevate the risk of suggestibility and confabulation. These issues can result in negative jurisprudence-related outcomes, including impulsive Miranda rights waivers, incorrect assumptions of competency, inaccurate or incomplete information gathering, misinterpretation of intent, witness reliability issues, court ordered treatment completion problems, probation and parole violations, false confessions, and false accusations. The aim of the present article is to explain the context in which these issues can arise and provide criminal justice, forensic mental health, and legal professionals with key guidelines that can assist in minimizing suggestibility and confabulation when interviewing persons with FASD. We hope that the suggestions and strategies presented in this article will reduce potential obstructions of justice and enhance the quality of information obtained from individuals impacted by FASD. A brief discussion is also provided to identify additional research and training opportunities needed to clarify "best practices" for professionals tasked with evaluating the challenges facing this unique population.

Soft on crime: Patients with ventromedial prefrontal cortex damage allocate reduced third-party punishment to violent criminals.

The human impulse to punish those who have unjustly harmed others (i.e., third-party punishment) is critical for stable, cooperative societies. Punishment selection is influenced by both harm outcome and the intent of the moral agent (i.e., the offender's knowledge of wrongdoing and desire that the prohibited consequence occur). We allocate severe punishments to those who commit violent crimes and milder punishments to those who commit non-violent crimes; and we allocate severe punishments to criminals who have malicious intent and milder punishments to criminals who lack malicious intent. Prior research has indicated that aversive, emotional responses of third-party judges may influence punishment allocation, as increased negative emotion correlates with more punitive punishments. Here, we show that patients with damage to the ventromedial prefrontal cortex (vmPFC; a region necessary for the normal generation of emotion), compared to other neurological patients and healthy adult participants, allocate more lenient third-party punishment to criminals who commit emotionally-evocative, violent crimes. By contrast, patients with vmPFC damage did not differ from comparison participants on punishment allocation for non-emotional, non-violent crimes. These results demonstrate the necessity of the vmPFC for the integration of emotion into third-party punishment decisions, and indicate that negative emotion influences third-party punishment allocation particularly for scenarios involving physical harm to another.

Arrested development: early prefrontal lesions impair the maturation of moral judgement.

Learning to make moral judgements based on considerations beyond self-interest is a fundamental aspect of moral development. A deficit in such learning is associated with poor socialization and criminal behaviour. The neural systems required for the acquisition and maturation of moral competency are not well understood. Here we show in a unique sample of neurological patients that focal lesions involving ventromedial prefrontal cortex, acquired during development, result in an abnormally egocentric pattern of moral judgement. In response to simple hypothetical moral scenarios, the patients were more likely than comparison participants to endorse self-interested actions that involved breaking moral rules or physically harming others in order to benefit themselves. This pattern (which we also found in subjects with psychopathy) differs from that of patients with adult-onset ventromedial prefrontal cortex lesions--the latter group showed normal rejection of egocentric rule violations. This novel contrast of patients with ventromedial prefrontal cortex lesions acquired during development versus during adulthood yields new evidence suggesting that the ventromedial prefrontal cortex is a critical neural substrate for the acquisition and maturation of moral competency that goes beyond self-interest to consider the welfare of others. Disruption to this affective neural system early in life interrupts moral development.

A quantitative meta-analysis of functional imaging studies of social rejection.

Early neuroimaging studies using Cyberball suggested that social rejection activated the pain matrix, as identified in studies of physical pain. However, these early studies were characterized by small sample sizes. Our statistical multi-level kernel density analysis (MKDA) of Cyberball neuroimaging studies with 244 participants fails to support the claim that social rejection operates on the same pain matrix as nociceptive stimuli, questioning whether social pain is more figurative or literal. We also performed an MKDA of the neuroimaging studies of reliving a romantic rejection to test whether the pain matrix was activated if the rejection were more meaningful. Results again failed to support the notion that rejection activates the neural matrix identified in studies of physical pain. Reliving an unwanted rejection by a romantic partner was significantly characterized by activation within and beyond the "Cyberball" brain network, suggesting that the neural correlates of social pain are more complex than previously thought.

Benefit of the doubt: a new view of the role of the prefrontal cortex in executive functioning and decision making.

The False Tagging Theory (FTT) is a neuroanatomical model of belief and doubt processes that proposes a single, unique function for the prefrontal cortex. Here, we review evidence pertaining to the FTT, the implications of the FTT regarding fractionation of the prefrontal cortex, and the potential benefits of the FTT for new neuroanatomical conceptualizations of executive functions. The FTT provides a parsimonious account that may help overcome theoretical problems with prefrontal cortex mediated executive control such as the homunculus critique. Control in the FTT is examined via the "heuristics and biases" psychological framework for human judgment. The evidence indicates that prefrontal cortex mediated doubting is at the core of executive functioning and may explain some biases of intuitive judgments.

A neuropsychological test of belief and doubt: damage to ventromedial prefrontal cortex increases credulity for misleading advertising.

We have proposed the False Tagging Theory (FTT) as a neurobiological model of belief and doubt processes. The theory posits that the prefrontal cortex is critical for normative doubt toward properly comprehended ideas or cognitions. Such doubt is important for advantageous decisions, for example in the financial and consumer purchasing realms. Here, using a neuropsychological approach, we put the FTT to an empirical test, hypothesizing that focal damage to the ventromedial prefrontal cortex (vmPFC) would cause a "doubt deficit" that would result in higher credulity and purchase intention for consumer products featured in misleading advertisements. We presented 8 consumer ads to 18 patients with focal brain damage to the vmPFC, 21 patients with focal brain damage outside the prefrontal cortex, and 10 demographically similar healthy comparison participants. Patients with vmPFC damage were (1) more credulous to misleading ads; and (2) showed the highest intention to purchase the products in the misleading advertisements, relative to patients with brain damage outside the prefrontal cortex and healthy comparison participants. The pattern of findings was obtained even for ads in which the misleading bent was "corrected" by a disclaimer. The evidence is consistent with our proposal that damage to the vmPFC disrupts a "false tagging mechanism" which normally produces doubt and skepticism for cognitive representations. We suggest that the disruption increases credulity for misleading information, even when the misleading information is corrected for by a disclaimer. This mechanism could help explain poor financial decision-making when persons with ventromedial prefrontal dysfunction (e.g., caused by neurological injury or aging) are exposed to persuasive information.

Authoritarianism, religious fundamentalism, and the human prefrontal cortex.

OBJECTIVE: The psychological processes of doubting and skepticism have recently become topics of neuroscientific investigation. In this context, we developed the False Tagging Theory, a neurobiological model of the belief and doubt process, which proposes that the prefrontal cortex is critical for normative doubt regarding properly comprehended cognitive representations. Here, we put our theory to an empirical test, hypothesizing that patients with prefrontal cortex damage would have a doubt deficit that would manifest as higher authoritarianism and religious fundamentalism. METHOD: Ten patients with bilateral damage to the ventromedial prefrontal cortex (vmPFC), 10 patients with damage to areas outside the vmPFC, and 16 medical comparison patients, who experienced life-threatening (but non-neurological) medical events, completed a series of scales measuring authoritarianism, religious fundamentalism, and specific religious beliefs. RESULTS: vmPFC patients reported significantly higher authoritarianism and religious fundamentalism than the other groups. The degrees of authoritarianism and religious fundamentalism in the vmPFC group were significantly higher than normative values, as well; by contrast, the comparison groups did not differ from normative values. Moreover, vmPFC patients reported increased specific religious beliefs after brain injury. CONCLUSIONS: The findings support the False Tagging Theory and suggest that the vmPFC is critical for psychological doubt and resistance to authoritarian persuasion.

Dimensions of personality disturbance after focal brain damage: investigation with the Iowa Scales of Personality Change.

This study employed a multistep, rational-empirical approach to identify dimensions of personality disturbance in brain-damaged individuals: (a) Five dimensions were hypothesized based on empirical literature and conceptual grounds; (b) principal components analysis was performed on the Iowa Scales of Personality Change (ISPC) to determine the pattern of covariance among 30 personality characteristics; (c) when discrepancies existed between principal components analysis results and conceptually based dimensions, empirical findings and clinical considerations were weighed to determine assignment of ISPC scales to dimensions; (d) the fit of data to the refined dimensions was assessed by examination of intercorrelations; (e) differential predictions concerning the relationship of dimensions to ventromedial prefrontal cortex (vmPFC) damage were tested. This process resulted in the specification of five dimensions: Disturbed Social Behavior, Executive/Decision-Making Deficits, Diminished Motivation/Hypo-Emotionality, Irascibility, and Distress. In accord with predictions, the 28 participants with vmPFC lesions, compared to 96 participants with focal lesions elsewhere in the brain, had significantly more Disturbed Social Behavior and Executive/Decision-Making Deficits and tended to have more Diminished Motivation/Hypo-Emotionality. Irascibility was not significantly higher among the vmPFC group, and the groups had very similar levels of Distress. The findings indicate that conceptually distinctive dimensions with differential relationships to vmPFC can be derived from the Iowa Scales of Personality Change.

Naming dynamic and static actions: neuropsychological evidence.

There has been considerable interest in identifying the neural correlates of action naming, but the bulk of previous work on this topic has utilized static stimuli. Recent research comparing the visual processing of dynamic versus static actions suggests that these two types of stimuli engage largely overlapping neural systems, raising the possibility that the higher-order processing requirements for naming dynamic and static actions might not be very different. To explore this issue in greater depth, we developed the Dynamic Action Naming Test (DANT), which consists of 158 video clips 3-5s in length, for each of which the participant is asked to produce the most appropriate verb. We administered the DANT to 78 brain-damaged patients drawn from our Patient Registry, and to a demographically matched group of 50 normal participants. Out of the 16 patients who performed defectively on the DANT, nearly all (15/16) had damage in the left hemisphere. Lesion analysis indicated that the frontal operculum was the most frequent area of damage in the 15 patients; also, damage to the posterolateral temporal-occipital sector (in and near MT) was specifically related to defective dynamic action naming. Most of the brain-damaged participants (n=71) also received our Static Action Naming Test (SANT), and we found that performances on verb items that were common across the DANT and SANT were highly correlated (R=.91). Moreover, patients who failed the DANT almost invariably also failed the SANT. These findings lend further support to the hypothesis that there is considerable commonality in the neural systems underlying the use of verbs to orally name dynamic and static actions, a conclusion that is in turn compatible with the concept of "representational momentum". Our results also contribute more generally to the rapidly growing field of research on embodied cognition.