Children's conceptual knowledge of lying and its relation to their actual behaviors: implications for court competence examinations.

Child witnesses must undergo a competence examination in which they must show appropriate conceptual understanding of lying and truth-telling, and promise to tell the truth. Three experiments (Ns = 123, 103, 177) were conducted to address the assumptions underlying the court competence examination that (1) children who understand lying and its moral implications are less likely to lie and (2) discussing the conceptual issues concerning lying and having children promising to tell the truth promotes truth-telling. Both measures of lying and understanding of truth- and lie-telling were obtained from children between 3 and 7 years of age. Most children demonstrated appropriate conceptual knowledge of lying and truth-telling and the obligation to tell the truth, but many of the same children lied to conceal their own transgression. Promising to tell the truth significantly reduced lying. Implications for legal systems are discussed.

Knowledge of legal terminology and court proceedings in adults with developmental disabilities.

This research compared 40 adults with mild developmental disabilities (DD) and 40 nondelayed adults (ND) in terms of knowledge of legal terms and court proceedings. For all of the 34 terms studied, with the exception of "police office" there were significant differences between the DD and ND groups with respect to degree of conceptual understanding of terms. Results indicate that all but 6 terms assessed (adjourn, allegation, crown attorney, defendant, prosecute, and court reporter) were well-defined by 85% or more of ND participants. In contrast, only 8 of the terms (police officer, lawyer, jail, court, lie, truth, judge, and witness) were reasonably conceptually understood by at least 75% of DD participants. Reported familiarity with terms in DD participants is not a reliable indicator of actual familiarity with terms. Results are discussed with respect to the need for education of DD individuals and legal professionals to support participation and fair treatment of DD individuals in legal situations.

Problems in using health survey questionnaires in older patients with physical disabilities. Can proxies be used to complete the SF-36?

BACKGROUND: The SF-36 Health Survey questionnaire has been proposed as a generic measure of health outcome. However, poor rates of return and high levels of missing data have been found in elderly subjects and, even with face-to-face interview, reliability and validity may still be disappointing, particularly in cognitively impaired patients. These patients may be the very patients whose quality of life is most affected by their illness and their exclusion will lead to biased evaluation of health status. A possible alternative to total exclusion is the use of a proxy to answer on the patient's behalf, but few studies of older people have systematically studied patient-proxy agreement. OBJECTIVE: To compare the agreement between patients, lay and professional proxies when assessing the health status of patients with the SF-36. METHODS: The SF-36 was administered by interview to 164 cognitively normal, elderly patients (Mini-mental State Examination 24 or more) referred for physical rehabilitation. The SF-36 was also completed by a patient-designated lay proxy (by post) and a professional proxy. Agreement between proxies and patients was measured by intraclass correlation coefficients (ICCs), and a bias index. RESULTS: Professional proxies were better able to predict the patients' responses than were the lay proxies. Criterion levels of agreement (ICC 0.4 or over) were attained for four of the eight dimensions of the SF-36 by professional proxies, but for only one dimension by lay proxies. In professional proxies, the magnitude of the bias was absent or slight (<0.2) for six of the eight dimensions of the SF-36 with a small (0.2-0.49) negative bias for the other two. Lay proxies showed a negative bias (i.e. they reported poorer function than did the patients themselves) for seven of the eight dimensions of the SF-36 (small in two and moderate (0.5-0.79) in five). CONCLUSIONS: For group comparisons using the SF-36, professional proxies might be considered when patients cannot answer reliably for themselves. However, in the present study, lay proxy performance on a postal questionnaire showed a strong tendency to negative bias. Further research is required to define the limitations and potentials of proxy completion of health status questionnaires.

The relationship between criminal charges, diagnoses, and psycholegal opinions among federal pretrial defendants.

This study analyzed data from 1710 criminal defendants referred by federal courts throughout the United States. We examined 12 categories of criminal charges with respect to diagnosed psychopathology and opinions related to competence to stand trial (CST) and criminal responsibility (CR) at the time of the alleged offense. Overall, 18% of the present sample were found to be incompetent to stand trial, while 12% were found to be not criminally responsible or 'insane.' In this study, crimes were associated with rates of psychopathology and rates of opinions regarding CST and CR. The findings of this study suggest that individuals who are charged with different crimes have different mental states and psychopathology and are therefore found to have differential rates of competence and sanity.

A systematic investigation of 16 cases of neonaticide.

OBJECTIVE: Neonaticide, or infant murder on the day of birth, is often preceded by denial of pregnancy. The preponderance of case reports of neonaticide describes a pattern of pregnancy denial, dissociation, and ego disorganization. The author systematically investigated the clinical characteristics of 16 women charged with homicide in the United States after alleged neonaticides. METHOD: The women received a psychiatric evaluation and were administered the Dissociative Experiences SCALE: RESULTS: Nearly all of the women reported similar precipitants and symptoms, including depersonalization, dissociative hallucinations, and intermittent amnesia at delivery. CONCLUSIONS: The characteristics of the women in the study were similar to those reported in the literature on neonaticide. The existence of this common pattern suggests that treatment strategies can be designed for women at risk for neonaticide.

Juveniles adjudicated incompetent to proceed: a descriptive study of Florida's Competence Restoration program.

Although competence to stand trial is perhaps the most studied area of mental health law, most of the research has been focused on adults. This study describes a population of 471 juveniles committed for treatment/habilitation and restoration of their competence to proceed in the delinquency process. This population differed from their adult counterparts in important ways. For example, 58 percent of the juveniles had a diagnosis of mental retardation, and 57 percent of the juveniles with an Axis I diagnosis also had a diagnosis of conduct disorder. Only 17 percent had a diagnosed psychotic disorder. Diagnoses among cohorts of adults found incompetent differ markedly. However, similar to adult defendants who are adjudicated incompetent to proceed, the majority of these children were returned to court after treatment staff determined that they were competent to proceed. Contrary to expectation, there were no significant age-related differences with respect to the recommendation of clinical staff regarding restoration of competence. The data suggest the need for further research examining that subset of children in the juvenile justice system whose competence to proceed is questionable.

From case management to court clinic: examining forensic system involvement of persons with severe mental illness.

The study examined the flow of a state mental health agency's case-managed clients into its forensic mental health court clinic systems for evaluation of competency to stand trial (CST) for a criminal offense. An analysis of merged encounter data from the case management and court clinic systems revealed that roughly 2% of the case-managed population were referred to court clinics for evaluation of CST during a 1-year period, but that these 2% represented roughly one eighth of that year's court clinic evaluees. The likelihood of this involvement was higher for males, African-Americans, and Latinos, and for persons with a history of substance abuse, and also was associated with higher levels of previous hospitalization. In addition, CST evaluees were more likely to be non-White, male, and uninsured than were case-managed evaluees. These data indicate that demographic characteristics, substance abuse, and lack of insurance are potential risk factors for forensic and, by inference, criminal justice system involvement among persons with mental illness.

Repeated arson: data from criminal records.

The criminal careers of all arsonists convicted in former West-Germany between 1983 and 1985 who were found not to be responsible due to diminished responsibility for psychiatric reasons and a random sample (every third) of all criminally liable arsonists during the same period of time were followed up until 1994 by means of their trial records. Reappearance before the court for arson did not differ between the groups. When subjects are grouped by the additional occurrence of crimes other than arson, however, arsonists with diminished responsibility are the most problematic group: In comparison with all other subgroups, the arsonists who were partly responsible who did not commit any crimes other than arson showed the highest number of fire-setting incidents. Among the arsonists who committed other crimes as well, arsonists with diminished responsibility had the highest number of additional offences.

Competency to stand trial in family court: characteristics of competent and incompetent juveniles.

Competency to stand trial (CST) has been among the most thoroughly researched psycholegal issues in the past 20 years. However, little attention has been given to CST in juveniles facing delinquency or criminal proceedings. In a sample of 112 pretrial juvenile defendants undergoing court-ordered CST evaluations, 14 percent of the sample was judged incompetent to stand trial (IST). Sixty-one (55%) were considered to have one or more examiner-cited competency deficits that might lead the court to a finding of IST. Only age, intelligence level, and history of previous juvenile arrest differentiated competent from incompetent juveniles. Implications of the results for raising the CST issue in family or circuit courts are discussed as are suggestions for future research.

A patient-centered approach to advance medical planning in the nursing home.

OBJECTIVE: The objective of this study is to determine whether nursing home residents or their surrogates are willing and able to prioritize their goals for care and to demonstrate how these rankings can form the basis of a specific pattern of medical care. DESIGN: A prospective, descriptive study. SETTING: A 40-bed nursing unit for residents with mild to moderate impairments in a 725-bed teaching nursing home. RESULTS: Overall, 78% of patients or their families were willing to prioritize their goals, allowing the investigators to infer a pattern of care. The goals were interpreted as implying an intensive pattern in 21%, a comprehensive pattern in 16%, a basic pattern in 18%, palliation in 18%, and comfort only in 6% of residents. Goals chosen by residents who were able to select for themselves translated into more aggressive care than did the goals selected by surrogates. CONCLUSION: Goal-centered advance medical planning can be initiated in nursing homes by asking residents or their surrogates to prioritize their goals of care. These prioritizations can form the foundation for specific patterns of care.

Fitness, responsibility, and judicially ordered assessments.

OBJECTIVE: To compare the characteristics of individuals assessed for fitness to stand trial (FST) with those assessed for criminal responsibility (CR). METHOD: This study examines all the consecutive requests of FST or CR addressed to the only forensic psychiatric hospital in the province of Quebec and 2 prisons in the Montreal area over a 1-year period. RESULTS: In all, 170 FST, 52 CR, and 29 both FST and CR assessment requests were received (251 subjects). Psychiatrists' recommendations and court verdicts of unfitness to stand trial or not criminally responsible on account of mental disorders were mostly related to the presence of a psychotic-spectrum disorder. There is generally a good agreement between psychiatric recommendations and verdicts of the court, with the exception of unfitness recommendations. CONCLUSIONS: Defendants referred for a FST or a CR assessment displayed similar characteristics. However, although subjects with psychotic disorders represented more than one-half of the unfit or not criminally responsible verdicts, most of the subjects with psychoses were found competent to stand trial or responsible.

Fitness to stand trial: characteristics of remands since the 1992 Criminal Code amendments.

OBJECTIVE: To examine the characteristics of a sample of remands after the introduction of the 1992 Criminal Code amendments, to compare those deemed fit with those deemed unfit as the result of an institution-based evaluation of fitness, and to determine the impact of the Code changes on one's detention period by investigating the length of time that individuals were held on remand. METHOD: File information was collected and analyzed for 180 males who were remanded for inpatient evaluations of their fitness to stand trial between October 1994 and July 1995. RESULTS: The results indicated that remanded defendants are more likely to be single, unemployed, and living alone and that unfit defendants are significantly more likely to have never been married. As well, individuals who were found to be unfit to stand trial were significantly less likely to have been diagnosed with a drug- or alcohol-use disorder and were 4 times more likely to have been diagnosed with a psychotic disorder. The results also indicated that while the 1992 Criminal Code revisions called for a 5-day evaluation period, it appears that this is rarely accomplished, and, in fact, the average length of time for an assessment of fitness is 23 days. Finally, the majority of remanded individuals are certified and treated with psychotropic medications while on remand. CONCLUSION: The results of this study suggest that the fitness remand period is being used for purposes other than assessing fitness.

Dessarrollo cognitivo del niño sordo congénito durante el período sensoriomotor: contribución a las discusiones sobre pensamiento y lenguaje / Cognitive development of congenital deaf children during the sensoriomotor period: contribution to discussions on thought and language

Introducción. Se analiza el desarrollo cognitivo temprano del niño sordo congénito, en el contexto de las relaciones entre pensamiento y lenguaje de acuerdo con la teoría de Piaget, quien postula que el pensamiento precede al lenguaje verbal y ambos provienen de la interacción del niño con su medio social y objetal. Material y métodos. Estudio longitudinal del desarrollo cognitivo sensoriomotor de 3 niños sordos con diagnóstico confirmado de cortipatía bilateral congénita. Se realizaron evaluaciones periódicas del desarrollo cognitivo, entre los 18 y los 28 meses de edad. El instrumento para conocer el desarrollo sensoriomotor empleó las Escalas Ordinales del Desarrollo Psicológico de Uzgiris y Hunt. Resultados. Las nociones de permanencia del objeto, medios y fines, imitación gestual, causalidad operacional y la relación de los objetos en el espacio las completaron los 3 niños sordos congénitos a las edades de 21, 23 y 28 meses respectivamente. Aquellos dominios o estadios que requieren expresiones verbales no fueron resueltos por los niños, apareciendo como si estuvieran retardados en esos aspectos del desarrollo sensoriomotor. Conclusiones. Se interpretan estos hallazgos, en el sentido de que la inteligencia sensoriomotora del niño sordo congénito es igual a la del niño oyente, con excepción de aquellas habilidades ligadas específicamente a expresiones verbales, debido a sus limitaciones auditivas. Los datos apoyan la teoría de que el lenguaje no es indispensable para el desarrollo cognitivo al menos en esta etapa

Competency to consent to hospitalization in the medical patient.

A slightly modified version (the CQ-Med) of a 15-item competency questionnaire (the CQ) was used to assess competency to consent to hospitalization in general hospital patients. The purpose of the study was to determine whether voluntary psychiatric inpatients would score comparably with general hospital inpatients using a similar questionnaire. The patients studied performed better in nearly all areas of competency than the previously studied adult and adolescent psychiatric subjects using the same questionnaire (modified for the respective study populations). The CQ-Med questionnaire may be a useful instrument for preliminary screening of general hospital patients, when indicated, for assessment of competency to consent to hospitalization.

A preliminary report on the discrepancy between clinical and test evaluations of competence.

This report demonstrates the discrepancy that can occur between clinical and test evaluations of competence. It presents retrospective examination of 35 assessments of competence performed on 24 subjects by a multidisciplinary competency panel. The findings of the panel are compared with the subjects' results on the Cognitive Competency Test and on the Mini-Mental State Examination. The results show that the multidisciplinary competency panel will more often find subjects competent than indicated by their psychometric test scores. A process approach to the use of tests is recommended. Reliance on tests to decide the outcome of difficult cases does not appear to be warranted.