DGR2Starting From Zero

Objective: Although competence to stand trial is the most common criminal forensic psychological assessment, there is no significant literature regarding such assessments in non-English speakers in the United States. This case illustrates an approach when the examiner has no pre-existing knowledge of the evaluee's language or culture. Method: A 25-year-old Oromo laborer with 4 years of education was referred for assessment of an unknown cognitive or psychiatric disorder regarding adjudicative competence following eight previous such assessments. Evaluation techniques included an Internet search regarding his culture of origin, records review, consultation with his brothers and the interpreter, interview, limited physical examination, and selected neuropsychological testing. Results: History was congruent with a severe adolescent traumatic brain injury (TBI) and intellectual deficiency due to TBI. The evaluee's vague history was corroborated via family, Internet information, interpreter consultation, physical examination, and neuropsychological testing. Cultural and immigration considerations helped resolve incongruencies. Test of Memory Malingering (TOMM) was normal. Performance Index on Wechsler Adult Intelligence Scale-4th Edition (WAIS-4) was in the 50s. Formal (Woodcock–Johnson Achievement-III, Rey Figure) and informal language and drawing testing in English and Oromiffa were congruent with his history. The Fuld Object Memory Evaluation and 5-Digit Test were congruent with TBI. The Revised Competency Assessment Interview demonstrated little benefit from competency restoration classes. The judge accepted the report as resolving previous conflicting results. Conclusions: When data sources are less than satisfactory, seeking congruence across multiple information sources and types of information can improve confidence in the conclusions, especially when directed to specific referral questions. Testing can play a critical, although limited, role even in unconventional circumstances.

ADULT GRAND ROUNDS

Moderator: Richard Naugle

Discussants: Michael Schoenberg and Kevin Duff