Skip to main content
SpringerLink
Log in

Validity and Utility of the Miller Forensic Assessment of Symptoms Test (M-FAST) on an Inpatient Epilepsy Monitoring Unit

  • Published:
Psychological Injury and Law Aims and scope Submit manuscript

Abstract

As overreporting of symptoms threatens the integrity and utility of the neuropsychological evaluation, symptom validity test (SVT) usage has become a standard of practice. The Miller Forensic Assessment of Symptoms Test (M-FAST) SVT has been validated in various forensic contexts, though its utility in specific medical settings remains under-explored. The current study examined the validity and diagnostic utility of the M-FAST among 123 inpatient veterans on a long-term video electroencephalogram (V-EEG) epilepsy monitoring unit (EMU). Select scores from the Structured Inventory of Malingered Symptomatology and the Minnesota Multiphasic Personality Inventory-2-Restructured Form were combined into an SVT composite used as a criterion for validating the M-FAST with receiver operating characteristic (ROC) curves. A Student’s t-test revealed significantly higher total M-FAST scores among the symptom invalidity group compared to individuals with valid symptom reports (Cohen’s d = 1.24). An optimal M-FAST cut score of ≥ 5 was identified to detect symptom overreporting, with .65 sensitivity and .85 specificity (AUC = .82). However, ROC curve analysis indicated that the M-FAST had poor diagnostic classification accuracy for V-EEG-confirmed epilepsy (ES; n = 21) versus V-EEG-confirmed psychogenic non-epileptic events (PNEE; n = 46; AUC = .56). Although diagnostic utility of the M-FAST for PNEE versus ES was not supported within our sample, results demonstrate the validity of the M-FAST as an effective SVT in an EMU. Findings highlight that various cut scores may be considered to optimize detection of symptom overreporting in settings where comorbid physiological and psychological conditions may influence response validity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Availability of Data and Materials

All data and materials (as well as software application or custom code) support the claims herein and comply with field standards. Data sharing may be requested (but cannot be guaranteed, based on institutional polices). The data that support the findings of this study may be available upon submission of a reasonable request and the receipt of necessary approvals.

References

  • Benge, J. F., Wisdom, N. M., Collins, R. L., Franks, R., LeMaire, A., & Chen, D. K. (2012). Diagnostic utility of the Structured Inventory of Malingered Symptomatology for identifying psychogenic non-epileptic events. Epilepsy & Behavior, 24(4), 439–444. https://doi.org/10.1016/j.yebeh.2012.05.007

    Article  Google Scholar 

  • Ben-Porath, Y. S., & Tellegen, A. (2008). Minnesota Multiphasic Personality Inventory-2 Restructured Form: Manual for administration, scoring, and interpretation. University of Minnesota Press.

    Google Scholar 

  • Binder, L. M., & Salinsky, M. C. (2007). Psychogenic nonepileptic seizures. Neuropsychology Review, 17(4), 405-412. https://doi.org/10.1007/s11065-007-9047-5

  • Bodde, N. M. G., Brooks, J. L., Baker, G. A., Boon, P. A. J. M., Hendriksen, J. G. M., Mulder, O. G., & Aldenkamp, A. P. (2009). Psychogenic non-epileptic seizures—Definition, etiology, treatment and prognostic issues: A critical review. Seizure, 18(8), 543–553. https://doi.org/10.1016/j.seizure.2009.06.006

    Article  PubMed  Google Scholar 

  • Bomyea, J., Jurick, S. M., Keller, A. V., Hays, C. C., Twamley, E. W., & Jak, A. J. (2020). Neurobehavioral symptom validity and performance validity in veterans: Evidence for distinct outcomes across data types. Applied Neuropsychology: Adult, 27(1), 62–72. https://doi.org/10.1080/23279095.2018.1480484

    Article  Google Scholar 

  • Bush, S. S., Ruff, R. M., Tröster, A. I., Barth, J. T., Koffler, S. P., Pliskin, N. H., Reynolds, C. R., & Silver, C. H. (2005). Symptom validity assessment: Practice issues and medical necessity NAN policy & planning committee. Archives of Clinical Neuropsychology, 20(4), 419–426. https://doi.org/10.1016/j.acn.2005.02.002

    Article  PubMed  Google Scholar 

  • Carone, D. A. (2008). Children with moderate/severe brain damage/dysfunction outperform adults with mild-to-no brain damage on the Medical Symptom Validity Test. Brain Injury, 22(12), 960–971. https://doi.org/10.1080/02699050802491297

    Article  PubMed  Google Scholar 

  • Clegg, C., Fremouw, W., & Mogge, N. (2009). Utility of the Structured Inventory of Malingered Symptomatology (SIMS) and the Assessment of Depression Inventory (ADI) in screening for malingering among outpatients seeking to claim disability. The Journal of Forensic Psychiatry & Psychology, 20(2), 239–254. https://doi.org/10.1080/14789940802267760

    Article  Google Scholar 

  • Copeland, C. T., Mahoney, J. J., Block, C. K., Linck, J. F., Pastorek, N. J., Miller, B. I., Romesser, J. M., & Sim, A. H. (2016). Relative utility of performance and symptom validity tests. Archives of Clinical Neuropsychology, 31(1), 18–22. https://doi.org/10.1093/arclin/acv065

    Article  PubMed  Google Scholar 

  • Drane, D. L., Williamson, D. J., Stroup, E. S., Holmes, M. D., Jung, M., Koerner, E., Chaytor, N., Wilensky, A. J., & Miller, J. W. (2006). Cognitive impairment is not equal in patients with epileptic and psychogenic nonepileptic seizures. Epilepsia, 47(11), 1879–1886. https://doi.org/10.1111/j.1528-1167.2006.00611.x

    Article  PubMed  Google Scholar 

  • Del Bene, V. A., Rentería, M. A., Maiman, M., Slugh, M., Gazzola, D. M., Nadkarni, S. S., & Barr, W. B. (2017). Increased odds and predictive rates of MMPI-2-RF scale elevations in patients with psychogenic non-epileptic seizures and observed sex differences. Epilepsy & Behavior, 72, 43–50. https://doi.org/10.1016/j.yebeh.2017.04.023

    Article  Google Scholar 

  • Detullio, D., Messer, S. C., Kennedy, T. D., & Millen, D. H. (2019). A meta-analysis of the Miller Forensic Assessment of Symptoms Test (M-FAST). Psychological Assessment, 31(11), 1319–1328. https://doi.org/10.1037/pas0000753

    Article  PubMed  Google Scholar 

  • Erdodi, L. A., Abeare, C. A., Medoff, B., Seke, K. R., Sagar, S., & Kirsch, N. L. (2018). A single error is one too many: The forced choice recognition trial of the CVLT-II as a measure of performance validity in adults with TBI. Archives of Clinical Neuropsychology, 33(7), 845–860. https://doi.org/10.1093/acn/acx110

    Article  PubMed  Google Scholar 

  • Gervais, R., Green, P., Russell, A. S., Pieschl, S., & Allen, L. M., III. (2000). Failure on symptom validity tests associated with disability incentives in fibromyalgia patients. Archives of Clinical Neuropsychology, 15(8), 841–842. https://doi.org/10.1016/S0887-6177(00)80347-9

    Article  Google Scholar 

  • Guy, L. S., & Miller, H. A. (2004). Screening for malingered psychopathology in a correctional setting: Utility of the Miller-Forensic Assessment of Symptoms Test (M-FAST). Criminal Justice and Behavior, 31(6), 695–716. https://doi.org/10.1177/0093854804268754

    Article  Google Scholar 

  • Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J., Millis, S. R., & Conference Participants 1. (2009). American academy of clinical neuropsychology consensus conference statement on the neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist, 23(7), 1093-1129. https://doi.org/10.1080/13854040903155063

  • Howe, L. L., Anderson, A. M., Kaufman, D. A., Sachs, B. C., & Loring, D. W. (2007). Characterization of the Medical Symptom Validity Test in evaluation of clinically referred memory disorders clinic patients. Archives of Clinical Neuropsychology, 22(6), 753–761. https://doi.org/10.1080/13854040903155063

    Article  PubMed  Google Scholar 

  • Jackson, R. L., Rogers, R., & Sewell, K. W. (2005). Forensic applications of the Miller Forensic Assessment of Symptoms Test (M-FAST): Screening for feigned disorders in competency to stand trial evaluations. Law and Human Behavior, 29(2), 199–210. https://doi.org/10.1007/s10979-005-2193-5

    Article  PubMed  Google Scholar 

  • Jennette, K. J., Williams, C. P., Resch, Z. J., Ovsiew, G. P., Durkin, N. M., O’Rourke, J. J., Marceaux, J. C., Critchfield, E. A., & Soble, J. R. (2021). Assessment of differential neurocognitive performance based on the number of performance validity tests failures: A cross-validation study across multiple mixed clinical samples. The Clinical Neuropsychologist, 1–19. https://doi.org/10.1080/13854046.2021.1900398

  • Kaplan, M. J., Dwivedi, A. K., Privitera, M. D., Isaacs, K., Hughes, C., & Bowman, M. (2013). Comparisons of childhood trauma, alexithymia, and defensive styles in patients with psychogenic non-epileptic seizures vs. epilepsy: Implications for the etiology of conversion disorder. Journal of Psychosomatic Research, 75(2), 142–146. https://doi.org/10.1016/j.jpsychores.2013.06.005

  • Koreki, A., Garfkinel, S. N., Mula, M., Agrawal, N., Cope, S., Eilon, T., van Praag, C. G., Critchley, H. D., Edwards, M., & Yogarajah, M. (2020). Trait and state interoceptive abnormalities are associated with dissociation and seizure frequency in patients with functional seizures. Epilepsia, 61(6), 1156–1165. https://doi.org/10.1111/epi.16532

    Article  PubMed  PubMed Central  Google Scholar 

  • LaFrance, W. C., Jr., Baker, G. A., Duncan, R., Goldstein, L. H., & Reuber, M. (2013). Minimum requirements for the diagnosis of psychogenic nonepileptic seizures: A staged approach: A report from the International League Against Epilepsy Nonepileptic Seizures Task Force. Epilepsia, 54(11), 2005–2018. https://doi.org/10.1111/epi.12356

    Article  PubMed  Google Scholar 

  • Larrabee, G. J. (2003). Detection of malingering using atypical performance patterns on standard neuropsychological tests. The Clinical Neuropsychologist, 17(3), 410–425. https://doi.org/10.1076/clin.17.3.410.18089

    Article  PubMed  Google Scholar 

  • Larrabee, G. J. (2012). Performance validity and symptom validity in neuropsychological assessment. Journal of the International Neuropsychological Society: JINS, 18(4), 625–630.

    Article  PubMed  Google Scholar 

  • Locke, D. E., Kirlin, K. A., Thomas, M. L., Osborne, D., Hurst, D. F., Drazkowski, J. F., Sirven, J. I., & Noe, K. H. (2010). The Minnesota Multiphasic Personality Inventory-2-Restructured Form in the epilepsy monitoring unit. Epilepsy & Behavior, 17(2), 252–258. https://doi.org/10.1016/j.yebeh.2009.12.004

    Article  Google Scholar 

  • Lewis, J. L., Simcox, A. M., & Berry, D. T. R. (2002). Screening for feigned psychiatric symptoms in a forensic sample by using the MMPI-2 and the Structured Inventory of Malingered Symptomatology. Psychological Assessment, 14(2), 170–176. https://doi.org/10.1037/1040-3590.14.2.170

    Article  PubMed  Google Scholar 

  • Miller, H. A. (2001). Miller forensic assessment of symptoms test: M-fast; professional manual. Psychological Assessment Resources.

  • Miller, H. A. (2004). Examining the use of the M-FAST with criminal defendants incompetent to stand trial. International Journal of Offender Therapy and Comparative Criminology, 48(3), 268–280. https://doi.org/10.1177/0306624X03259167

    Article  PubMed  Google Scholar 

  • Miller, H., Guy, L., & Davila, M. (2001). The use of the M-FAST with disability claimants [Poster Presentation]. American Psychological Association Annual Conference. San Francisco, CA.

  • Miller, H. A. (2005). The Miller-Forensic Assessment of Symptoms Test (M-FAST) test generalizability and utility across race literacy, and clinical opinion. Criminal Justice and Behavior, 32(6), 591–611. https://doi.org/10.1177/0093854805278805

    Article  Google Scholar 

  • Modiano, Y. A., Webber, T. A., Cerbone, B., Haneef, Z., & Pastorek, N. J. (2021). Predictive Validity of the Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) in Differentiating Psychogenic Non-epileptic Seizures and Epileptic Seizures in Male Veterans. Epilepsy and Behavior, 116, 107731. https://doi.org/10.1016/j.yebeh.2020.107731

    Article  PubMed  Google Scholar 

  • Nelson, J. M., & Lovett, B. J. (2019). Assessing ADHD in college students: Integrating multiple evidence sources with symptom and performance validity data. Psychological Assessment, 31(6), 793–804. https://doi.org/10.1037/pas0000702

    Article  PubMed  Google Scholar 

  • Rosales, R., Dworetzky, B., & Baslet, G. (2020). Cognitive-emotion processing in psychogenic nonepileptic seizures. Epilepsy & Behavior, 102, 106639. https://doi.org/10.1016/j.yebeh.2019.106639

    Article  Google Scholar 

  • Salinsky, M., Binder, L., Storzbach, D., Parko, K., Rutecki, P., Goy, E., & Tadrous-Furnanz, S. (2020). Validity testing in veterans with epileptic seizures and psychogenic nonepileptic seizures. Epilepsy & Behavior, 111, 107246. https://doi.org/10.1016/j.yebeh.2020.107246

    Article  Google Scholar 

  • Schroeder, R. W., Martin, P. K., Heinrichs, R. J., & Baade, L. E. (2019). Research methods in performance validity testing studies: Criterion grouping approach impacts study outcomes. The Clinical Neuropsychologist, 33(3), 466–477. https://doi.org/10.1080/13854046.2018.1484517

    Article  PubMed  Google Scholar 

  • Sherman, E. M., Slick, D. J., & Iverson, G. L. (2020). Multidimensional malingering criteria for neuropsychological assessment: A 20-year update of the malingered neuropsychological dysfunction criteria. Archives of Clinical Neuropsychology, 35(6), 735–764. https://doi.org/10.1093/arclin/acaa019

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, G. P., & Burger, G. K. (1997). Detection of malingering: Validation of the Structured Inventory of Malingered Symptomatology (SIMS). Journal of the American Academy of Psychiatry and the Law Online, 25(2), 183–189.

    Google Scholar 

  • Soble, J. R., Alverson, W. A., Phillips, J. I., Critchfield, E. A., Fullen, C., O’Rourke, J. J., Messerly, J., Highsmith, J. M., Bailey, K. C., Webber, T. A., & Marceaux, J. C. (2020). Strength in numbers or quality over quantity? Examining the importance of criterion measure selection to define validity groups in performance validity test (PVT) research. Psychological Injury and Law, 13(1), 44–56. https://doi.org/10.1007/s12207-019-09370-w

    Article  Google Scholar 

  • Swets, J. A. (1988). Measuring the accuracy of diagnostic systems. Science, 240(4857), 1285–1293. https://doi.org/10.1126/science.3287615

    Article  PubMed  Google Scholar 

  • Sullivan, B. K., May, K., & Galbally, L. (2007). Symptom exaggeration by college adults in attention-deficit hyperactivity disorder and learning disorder assessments. Applied Neuropsychology, 14(3), 189–207. https://doi.org/10.1080/09084280701509083

    Article  PubMed  Google Scholar 

  • Syed, T. U., Arozullah, A. M., Loparo, K. L., Jamasebi, R., Suciu, G. P., Griffin, C., Mani, R., Syed, I., Loddenkemper, T., & Alexopoulos, A. V. (2009). A self-administered screening instrument for psychogenic nonepileptic seizures. Neurology, 72(19), 1646–1652. https://doi.org/10.1212/WNL.0b013e3181a55ef7

    Article  PubMed  Google Scholar 

  • Szaflarski, J. P., & Szaflarski, M. (2004). Seizure disorders, depression, and health-related quality of life. Epilepsy & Behavior, 5(1), 50-57. https://doi.org/10.1016/j.yebeh.2003.10.015

  • van Impelen, A., Merckelbach, H., Jelicic, M., & Merten, T. (2014). The Structured Inventory of Malingered Symptomatology (SIMS): A systematic review and meta-analysis. The Clinical Neuropsychologist, 28(8), 1336–1365. https://doi.org/10.1080/13854046.2014.984763

    Article  PubMed  Google Scholar 

  • Veazey, C. H., Wagner, A. L., Hays, J. R., & Miller, H. A. (2005). Validity of the Miller Forensic Assessment of Symptoms Test in psychiatric inpatients. Psychological Reports, 96(3), 771–774. https://doi.org/10.2466/pr0.96.3.771-774

    Article  PubMed  Google Scholar 

  • Vitacco, M. J., Rogers, R., Gabel, J., & Munizza, J. (2007). An evaluation of malingering screens with competency to stand trial patients: A known-groups comparison. Law and Human Behavior, 31(3), 249–260. https://doi.org/10.1007/s10979-006-9062-8

    Article  PubMed  Google Scholar 

  • Webber, T. A., Collins, R. L., Sullivan, K. L., Chen, D. K., & Grabyan, J. M. (2021). Clinical identification of psychogenic nonepileptic events using combinations of psychological tests in a veteran sample. Epilepsy & Behavior, 115, 107631. https://doi.org/10.1016/j.yebeh.2020.107631

    Article  Google Scholar 

  • Widows, M. R., & Smith, G. P. (2005). SIMS: Structured inventory of malingered symptomatology: Professional manual. PAR, Inc.

  • Wisdom, N. M., Callahan, J. L., & Shaw, T. G. (2010). Diagnostic utility of the Structured Inventory of Malingered Symptomatology to detect malingering in a forensic sample. Archives of Clinical Neuropsychology, 25(2), 118–125. https://doi.org/10.1093/arclin/acp110

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Michael E. DeBakey Veterans Affairs Medical Center, Mental Health Care Line, 2002 Holcombe Blvd, Houston, TX, 77030, USA

    Savanna M. Tierney, Troy A. Webber & Jonathan M. Grabyan

  2. Neurocognitive Specialty Group, Independent Practice, Houston, TX, USA

    Robert L. Collins

  3. Michael E. DeBakey Veterans Affairs Medical Center, Neurology Care Line, Houston, TX, USA

    Vitor H. Pacheco

  4. Department of Neurology, Baylor College of Medicine, Houston, TX, USA

    Vitor H. Pacheco

  5. Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA

    Jonathan M. Grabyan

Authors
  1. Savanna M. Tierney
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Troy A. Webber
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert L. Collins
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vitor H. Pacheco
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jonathan M. Grabyan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All the authors whose names appear on the submission (1) made substantial contributions to the conception or design of the work; the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; (2) drafted the work or revised it critically for important intellectual content; (3) approved the version to be published; and (4) agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Jonathan M. Grabyan.

Ethics declarations

Ethics Approval

All procedures were evaluated and approved as a retrospective study by the relevant institutional review boards (Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine).

Consent to Participate

The participants were assessed as part of a clinical evaluation during a long-term EMU stay. The examiners explained the limits of confidentiality and the patients’ voiced understanding of the purpose of the evaluation before agreeing to participate in testing. Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare no competing interests.

Disclaimer

The views expressed herein are those of the authors and do not necessarily reflect the views or the official policy of the Department of Veterans Affairs or U.S. Government.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tierney, S.M., Webber, T.A., Collins, R.L. et al. Validity and Utility of the Miller Forensic Assessment of Symptoms Test (M-FAST) on an Inpatient Epilepsy Monitoring Unit. Psychol. Inj. and Law 14, 248–256 (2021). https://doi.org/10.1007/s12207-021-09418-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12207-021-09418-w

Keywords

Search

Navigation