Assessing Feigned Cognitive Impairment in Defendants Hospitalized for Competency Restoration: Further Validation of the TOMI

Abstract

Valid screens for feigned cognitive impairment are a fundamental component of any forensic assessment. The TOMI is a verbally administered, two-alternative forced-choice screen for feigned cognitive impairment in competence to stand trial (CST) evaluations. The present study provided further validation for the use of this tool in a sample of 82 forensic inpatients, the second investigation of the TOMI in a real-world, psycholegal context. Using three independent external criteria—the Test of Memory Malingering (TOMM) Trial 2 score, TOMM Retention Trial score, and a clinical treatment team decision—and these combined criteria—the Legal Knowledge scale (TOMI-L) evidenced high levels of sensitivity and specificity and excellent negative predictive power (NPP). The General Knowledge scale (TOMI-G) demonstrated poor sensitivity but high specificity and NPP. The authors discuss the utility of both scales in guiding and streamlining more thorough assessments of response styles in CST evaluations.