10 1 1 899 8590

10.
1177/0093854805278805
CRIMINAL JUSTICE AND BEHAVIOR
Miller / GENERALIZABILITY & UTILITY OF THE M-FAST
THE MILLER-FORENSIC
ASSESSMENT OF SYMPTOMS
TEST (M-FAST)
Test Generalizability and Utility Across
Race, Literacy, and Clinical Opinion
HOLLY A. MILLER
Sam Houston State University
The Miller-Forensic Assessment of Symptoms Test (M-FAST) was developed to provide clini-
cians with a reliable and valid screen for malingered mental illness. Previous studies have dem-
onstrated the development and initial validation of the M-FAST. The current analyses extend the
M-FAST generalizability across literacy status and race and compare predictive utility with clin-
ical opinion. Study 1 includes a sample of 280 forensic male psychiatric patients, 5 psychiatrists,
and 8 psychologists. The psychiatric participants were administered the SIRS, M-FAST item
pool, M Test, and MMPI-2. Study 2 includes an independent sample of 50 male forensic psychi-
atric participants and the 13 mental health professionals. Results provide evidence of
generalizability of the M-FAST across literacy and racial groups. Results also indicate that the
M-FAST produced higher classification accuracy than the M Test and clinical opinion, signifi-
cantly reducing the number of false negatives at the screening stage of malingering assessment.
Keywords: M-FAST; malingering; test generalizability; clinical opinion
I t has been estimated that base rates of malingering vary across set-
tings. Survey data have indicated malingered mental illness rates
from 7% to 21% in general and forensic settings, respectively (Rogers,
1986; Rogers, Salekin, Sewell, & Goldstein, 1996; Rogers, Sewell, &
AUTHOR NOTE: Partial funding for this dissertation work was provided by the
Kellogg Dissertation Research Grant Fund. Please address correspondence to Holly
A. Miller, College of Criminal Justice, Sam Houston State University, Huntsville, TX
77341-2296. E-mail: hmiller@shsu.edu
CRIMINAL JUSTICE AND BEHAVIOR, Vol. 32 No. 6, December 2005 591-611
DOI: 10.1177/0093854805278805
© 2005 American Association for Correctional and Forensic Psychology
591
Downloaded from cjb.sagepub.com at PENNSYLVANIA STATE UNIV on May 9, 2016

592 CRIMINAL JUSTICE AND BEHAVIOR
Goldstein, 1994). From these data, a routine screen for malingered

mental illness is warranted. Currently, the Structured Interview of
Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) is com-
monly used to specifically assess malingering status. The SIRS was
developed to specifically assess malingering and has demonstrated
effectiveness across many settings (Rogers et al., 1992). However, the
SIRS requires approximately 45 minutes to administer and does not
serve as an efficient screening tool for malingered mental illness.
The Miller-Forensic Assessment of Symptoms Test (M-FAST;
Miller, 2001) was developed to provide the clinician and forensic
examiner with a valid screen for malingered mental illness. In clinical
and forensic populations, the M-FAST could improve utilization of
resources by requiring a complete malingering assessment on only
those individuals who were identified positively on the screen. The M-
FAST is a 25-item structured interview that includes items developed
from seven strategies (explained in the Method section of Study 1)
found previously to differentiate malingerers from honest responders.
Previous studies have demonstrated the development and validation
of the M-FAST with both simulation and known-group designs and
found that the M-FAST total cut score of six provides the best classifica-
tion rates for forensic psychiatric patients incompetent to proceed with
trial (Jackson, Rogers, & Sewell, 2005; Miller, 2001; Miller, 2004),
disability claimants (Miller, Guy, & Davila, 2001), and prison inmates
(Guy & Miller, 2004). The current analyses sought to test M-FAST gen-
eralizability and utility across literacy and race. In addition, the predic-
tive accuracy of the M-FAST will be compared to clinical opinion.
Generalizability
The M-FAST was developed as a structured interview primarily

because of the higher incidence of illiteracy in forensic populations and
in acknowledgment of the diagnostic value of structured interviews
(Rogers et al., 1992). Another advantage of the structured interview
format is that it allows the examiner to make systematic clinical rat-
ings on the client’s presentation as well as on the content of his or her
responses. Although the structured interview format of the M-FAST is
reported as an advantage, the generalizability and utility of the M-
FAST has not been examined across literate and illiterate groups.

Miller / GENERALIZABILITY & UTILITY OF THE M-FAST 593
Another important consideration in the generalizability of the M-

FAST is the utility of the screening measure across race. M-FAST
results can influence important decisions about individual liberties,
access to treatment, and monetary gains. Thus, it is vital that the M-
FAST is applied fairly in such contexts (American Educational
Research Association & American Psychological Association, 1999).
Although the populations in which the M-FAST were developed and
validated were culturally and ethnically diverse, the utility across race
has not been examined extensively. Currently, one M-FAST study
(Guy & Miller, 2004) has examined utility across race. This study
found classification equity with African American (n = 18) and Cau-
casian (n = 26) correctional inmates.
The SIRS (Rogers et al., 1992), the criterion used in the develop-
ment of the M-FAST, has been examined across race. Studies (Rogers,
1997a) have found comparable results across ethnic groups. For ex-
ample, Connell (1991, cited in Rogers, 1997b) found no significant
differences due to race by performing a MANOVA on the date derived
from 30 African Americans and 60 Caucasian participants. However,
simply because the M-FAST was developed by using the SIRS as the
criterion, it does not assume the M-FAST will demonstrate racial/
ethnic equality of results.
Utility
A current debate in forensic psychology and in the legal system is

the accuracy of clinical opinion versus actuarial prediction. In foren-
sic assessment, psychologists and psychiatrists are often called to pro-
vide expert opinion on issues in which malingering is a component
(e.g., competency, insanity, personal injury). Since the Daubert v.
Merrell Dow Pharmaceuticals, Inc. (1993) decision, legal rules on
admissibility of expert testimony (measures and opinions) have be-
come more stringent in most jurisdictions. Although clinical opinion
has been compared to actuarial measures in the area of risk assess-
ment, clinical opinion has not been compared to the actuarial predic-
tion of malingering.
Of particular importance is the screening procedure for possible
malingering. During this stage, it is often decided which patients need
further assessment, medication, or treatment. If the clinician has the

opinion that the patient might be malingering, further assessment with

interviews and instruments can examine the hypothesis further. How-
ever, if the clinician has the opinion that the patient is honest in his or
her self-report, the clinician may make a false-negative prediction of
malingering status. This mistake may be more detrimental than a false
positive because malingering status may not be explored and extended
resources (or inaccurate legal status) may be given to a patient who is
malingering rather than a bona fide patient who is in need of services;
whereas in the false-positive case, there may only be extra expense on
further assessment to determine accurate diagnosis. To date, no stud-
ies have compared the clinical opinion of malingering status with an
actuarial prediction.
Current Analyses
The current analyses examine the generalizability and utility of the

M-FAST across literacy, race, and clinical opinion using the develop-
ment and initial validation samples of the screening measure. Study 1
gives preliminary results examining M-FAST utility of literate and
illiterate participants and compares utility/predictive power of an
actuarial screening measure and clinical opinion.
Study 2 provides evidence for the 25-item M-FAST across literacy
and racial groups. Study 2 also compares utility/predictive power of
the M-FAST, M Test, and clinical opinion on the final 25-item M-
FAST. These results provide further evidence of the M-FAST’s use as
a screening tool for malingering and widen its generalizability.
STUDY 1: PRELIMINARY GENERALIZABILITY AND

UTILITY OF THE M-FAST ITEMS
METHOD
Participants
The sample included 280 psychiatric patients and 13 mental health

professionals. Psychiatric participants were patients in the forensic
units of a state hospital, located in the southeast region of the United

States, who had been determined incompetent to proceed with trial

because of a mental illness. The psychiatric participants were 18- to 71-
year-old males who had criminal charges ranging from trespassing to
murder. The majority of the sample was being administered psycho-
tropic medication, although specific information was not collected.
Every patient in these units was approached to participate in the
study, unless the interviewer was told by hospital staff that the patient
was too dangerous to be interviewed. Participants were selected based
on their ability to comprehend the informed consent information. Psy-
chiatric patients were not included in the project if they were unable to
discuss the informed consent in a manner that portrayed that they
understood the purpose of the study or the fact that participation was
completely voluntary. In other words, if a patient was not able to
repeat back the purpose of the study and that it was voluntary and
anonymous, he was not included in the sample. Similar to other stud-
ies using psychiatric samples (Rogers, 1997a), approximately 25% of
the forensic population did not participate in the study due to their
dangerousness, inability to comprehend the informed consent and
assessment procedures, or refusal to participate. None of the patients
included in the study received a reward or incentive for participation.
The 13 mental health professionals included 5 psychiatrists and 8
psychologists serving on eight different treatment teams for the psy-
chiatric patients at the state hospital. All of the mental health profes-
sionals had been employed at the hospital for longer than 2 years and
encompassed the entire psychiatrist and psychologist treatment staff.
Each psychiatrist and psychologist had a caseload of approximately
25 forensic inpatients. Because all of the mental health professionals
had been employed in the forensic units for at least 2 years, and their
average time of employment was 5.6 years (SD = 6), their experience
with malingering assessment was extensive.
Instruments
Miller-Forensic Assessment of Symptoms Test (M-FAST) item pool.

The M-FAST item pool was made up of structured interview questions
for the assessment of malingering. The item pool included true/false
questions, multiple-choice questions, and one suggestion. Seventy-

nine items were rationally derived from the following seven strategies
that previously have been demonstrated to distinguish individuals
who were malingering from honest responders: (a) unusual hallucina-
tions, (b) reported versus observed, (c) extreme symptomatology, (d)
rare combinations, (e) negative image, (f) unusual symptom course,
and (g) suggestibility (see Miller, 2001, for a more detailed descrip-
tion of the strategies).
Structured Interview of Reported Symptoms (SIRS). The SIRS

(Rogers et al., 1992) was designed to be part of a multimethod ap-
proach for the detection of malingered mental illness. The SIRS has
been validated through an integration of simulation and known-
groups designs and uses 13 scales that correspond with malingering.
Eight of the 13 scales are referred to as primary scales because they
have consistently yielded significant differences between feigners
and honest responders in four separate validation studies. The primary
scales are useful in the description of response styles and in the classi-
fication of malingering. The remaining 5 scales, supplementary
scales, were retained chiefly for the interpretation of response styles.
Established classification rates have also been reported and repli-
cated for the SIRS (Rogers et al., 1992). The authors report overall
accuracy rates based on single primary scale elevations ranging from
44% to 93%. The probability of feigning was developed based on
combinations of SIRS scale scores. These probabilities are as follows:
82% likelihood of feigning for two scales in probable range; 98% like-
lihood of feigning for three scales in probable range; and 100% likeli-
hood of feigning for four or more scales in probable range.
M Test. The M Test (Beaber, Marston, Michelli, & Mills, 1985) was
among the first attempts to develop a screening measure to detect
malingering, specifically malingered schizophrenia. The M Test was
used as an additional validity measure because of previous use as a
concurrent validity measure and its focus on malingered schizophre-
nia. It was expected that the current psychiatric population would
encompass patients diagnosed with schizophrenia as well as patients
who were malingering schizophrenic symptoms.

Minnesota Multiphasic Personality Inventory-2 (MMPI-2). The

MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989)
F, Fb Scale, F(p) Scale, L Scale, and K Scale were used as additional
validity measures. These scales were chosen because of their previous
use to discriminate response styles. For example, the F, Fb, and F(p)
scales are considered infrequency scales because they are made up of
items that are endorsed infrequently by the normative sample of the
MMPI-2 (Greene, 1997). More specifically, the F(p) scale was devel-
oped by including items that were infrequently endorsed by psychiat-
ric patients (Arbisi & Ben-Porath, 1995). The L and K scales were
chosen to evaluate discriminant validity of the M-FAST. Both the L
and K scales are measures of defensive responding.
Clinical opinion survey. A clinical opinion survey was developed

that included two questions for the mental health professional staff.
These questions included the following: (a) Is Mr. [name] malinger-
ing his psychological symptoms? and (b) How confident are you in
your opinion? For Question 1, the respondent answered “yes” or “no”
to malingering status. For Question 2, the following responses were
given: “sure of my opinion”; “pretty sure of my opinion”; or “unsure
of my opinion.”
Procedure
The principal investigator or an undergraduate assistant who was

trained in the administration of all the instruments approached the
psychiatric participants to request their participation in the study. All
patients were approached within 3 weeks of their admission to the
state hospital. Once informed consent was obtained, the interviewer
administered the M-FAST item pool and the SIRS. Next, each partici-
pant completed the M Test and MMPI-2.1 If the participant was unable
to read several of the M Test and MMPI-2 questions, he was given the
M Test orally and completed the MMPI-2 by tape. These individuals
were placed in the illiterate group.
The participants were placed in either the honest group or the
malingering group depending on their scores on the SIRS. Whereas

the primary consideration in the development of the SIRS was to limit

the number of false positives because of the seriousness of mislabel-
ing an individual as a malingerer, the goal of a screening measure is to
limit the number of false negatives. Therefore, in this study, a partici-
pant was placed in the malingering group if he had at least two primary
SIRS scales in the probable feigning range and obtained a total SIRS
score greater than 76. All other participants were placed in the honest
group. This created an accurate classification rate somewhere be-
tween 82% and 100%.
The mental health professionals (psychiatrists and psychologists)
were asked for their clinical opinion after the treatment team had com-
pleted their admission interviews and file review of each partici-
pant. This process was usually completed within the 1st week of the
patient’s admission to the forensic unit. A researcher who was not
involved in the actual interview/assessment of the forensic psychiatric
patients collected the clinical opinions. Collection of clinical opinion
ceased after 272 (2 opinions for 136 psychiatric participants) opinions
had been collected due to the appropriate number for data analysis and
the busy schedules of the professional staff.
RESULTS
Generalizability
Description of the psychiatric sample is provided in Table 1. One of

the suggested strengths of the M-FAST is its ability to be used with
illiterate individuals. Thus, analyses were completed to examine any
differences between the literate (n = 222) and illiterate (n = 58) partici-
pants on M-FAST scores. Although the final items had not been
selected at this point, M-FAST (79 items) results were compared
between the two groups by Receiving Operating Characteristic (ROC)
analyses and one-way analysis of variance.
Two nonparametric ROC analyses were completed with the M-
FAST total score and malingering status (determined by the SIRS).
The first ROC was computed for the literate group and produced an
AUC of .89 (SE = .02), with a 95% confidence interval of .84 to .93
(see Figure 1). The second ROC analysis included illiterate partici-

TABLE 1: Description of the Forensic Psychiatric Sample in Study 1
Variable Forensic Psychiatric Sample (N = 280)
Age—Mean (SD) 35 (11)

Education—Mean (SD) 11 (2)
Marital status (%)
Single 71
Married 15
Divorced 12
Separated 2
Race (%)
Caucasian 46
African American 49
Hispanic 5
Literacy (%)
Literate 79
Illiterate 21
Malingering status (%)
Malingering 26
Nonmalingering 74
pants and indicated that the AUC was .89 (SE = .04), with a 95% confi-
dence interval of .80 to .97 (see Figure 2). An ANOVA was performed
to compare the M-FAST total score across groups and indicated a
nonsignificant difference between the literate and illiterate groups,
F(1, 280) = .15, p = .70. These results provide preliminary evidence
that there is little difference on M-FAST results between illiterate and
literate individuals.
Clinical Opinion
Clinical opinion data were collected on 136 of the 280 forensic psy-
chiatric participants. Although the final 25 items had not been chosen,
overall rates of accuracy were analyzed to examine the difference
between clinical opinion and use of an actuarial measure to screen for
malingered mental illness. General comparisons are provided through
ROC analyses (see Figure 3). For the psychiatric group, the AUC was
.72 (SE = .05), with a confidence interval of .62 to .81. The ROC for
the psychologist group produced an AUC of .80 (SE = .04), with a
confidence interval of .72 to .88. The M-FAST total score (79 items)

ROC Curve
1.00
.75
.50
Sensitivity
.25
0.00
0.00 .25 .50 .75 1.00
1 - Specificity
Diagonal segments produced by ties.
Figure 1: Receiving Operating Characteristic (ROC) Curve for the Literate Par-
ticipants (n = 222) in Study 1
ROC Curve
1.00
.75
.50
Sensitivity
.25
0.00
0.00 .25 .50 .75 1.00
1 - Specificity
Figure 2: Receiving Operating Characteristic (ROC) Curve for the Illiterate Par-
ticipants (n = 58) in Study 1

produced an AUC of .89 (SE = .02), with a confidence interval of .85 to

.93. The ROC analyses indicate that the actuarial instrument appears to
enhance the predictive accuracy of malingering status.
More specific utility analyses, using the SIRS results as the crite-
rion variable, indicated that the psychiatrists’ opinions produced 19
false positives and 17 false negatives. Analyses completed with the
psychologist group indicated that their opinions produced 15 false
positives and 11 false negatives. Because the M-FAST items were still
being analyzed for final selection, cut scores were not examined or
specific utility analyses completed.
STUDY 2: GENERALIZABILITY AND

UTILITY OF THE 25-ITEM M-FAST
METHOD
Participants
The sample included 50 psychiatric participants (independent sam-

ple from Study 1), incompetent to proceed with trial due to a mental
illness, who were patients in the forensic units of a southeastern state
hospital. The psychiatric participants were 18- to 70-year-old males
who had criminal charges. Each forensic participant was approached
and included in the study in the same manner as in Study 1. Five psy-
chiatrists and 8 psychologists also participated and were surveyed for
their clinical opinions on the malingering status of all 50 psychiatric
patients.
Instruments and Procedure
This study used identical instruments and procedures as explained

for the psychiatric forensic participants and mental health profession-
als in Study 1. The only exception is that the M-FAST included only
the 25 items selected for the final screening measure (Miller, 2001),
instead of the complete item pool.

ROC – Psychiatrist Opinion
1.00
.75
.50
Sensitivity
.25
0.00
0.00 .25 .50 .75 1.00
1 - Specificity
ROC – Psychologist Opinion
1.00
.75
.50
Sensitivity
.25
0.00
0.00 .25 .50 .75 1.00
1 - Specificity
ROC – M-FAST (79 items)
1.00
.75
.50
.25
Sensitivity
0.00
0.00 .25 .50 .75 1.00
1 - Specificity
Figure 3: Receiving Operating Characteristics (ROC) Comparisons Between

Clinical Opinion and the M-FAST in Study 1

TABLE 2: Description of the Forensic Psychiatric Sample in Study 2
Demographic Malingerers (n = 14) Honest Responders (n = 36)
Age (years)
Mean (SD) 33 (8.7) 39 (11.9)
Range 21 to 51 18 to 70
Education (years)
Mean (SD) 10 (2.2) 12 (2.5)
Range 5 to 14 8 to 16
Marital status (%)
Single 93 58
Married 7 8
Divorced 0 31
Separated 0 3
Race (%)
Caucasian 21 56
African American 57 39
Hispanic 14 3
Other 8 2
Literacy (%)
Literate 86 83
Illiterate 14 17
RESULTS
Generalizability
Demographic characteristics of the malingerers and honest respond-

ers are reported in Table 2. Utility and comparison estimates were con-
ducted comparing the literate (n = 42) with the illiterate (n = 8) partici-
pants generally by ROC analyses, ANOVAs on the M-FAST total score
and scales, and more specifically, by examining the predictive power
of the cut score of 6 (suggested cut score for this population; Miller,
2001) for each group. Figures 4 and 5 demonstrate the ROC curves for
each group. For the literate group, the ROC produced an AUC of .94
(SE = .04), with a confidence interval of .86 to 1.00. Similarly, the
ROC for the illiterate group produced an AUC of .92 (SE = .09), with a
confidence interval of .70 to 1.00. Group differences were also exam-
ined by ANOVAs. As Table 3 indicates, no significant differences
were found for the total M-FAST score or scales (the four scales that
retained an appropriate number of items to run the analyses) across lit-
eracy status for the malingering and honest responding groups.

1.00
.75
.50
Sensitivity
.25
0.00
0.00 .25 .50 .75 1.00
1 - Specificity
Figure 4: Receiving Operating Characteristic (ROC) Curve Indicating Diagnos-
tic Efficiency of the Miller-Forensic Assessment of Symptoms Test
(M-FAST) With the Literate Group in Study 2
ROC Curve
1.00
.75
.50
Sensitivity
.25
0.00
0.00 .25 .50 .75 1.00
1- Specificity
Figure 5: Receiving Operating Characteristic (ROC) Curve Indicating Diagnos-
tic Efficiency of the Miller-Forensic Assessment of Symptoms Test
(M-FAST) With the Illiterate Group in Study 2

TABLE 3: ANOVA Results With Miller-Forensic Assessment of Symptoms Test

(M-FAST) Scores and Literacy for the Malingerers and Honest Re-
sponders in Study 2
Literate Illiterate
M-FAST Scale M (SD) M (SD) df F p
Total score
Malingerers 13.2 (6.2) 10.5 (5.0) 1 0.33 .58
Honest 2.6 (3.1) 1.7 (3.2) 1 0.46 .50
Rare combinations
Malingerers 3.8 (1.8) 4.2 (2.0) 1 0.79 .39
Honest 0.5 (0.8) 0.1 (0.4) 1 1.13 .30
Unusual hallucinations
Malingerers 2.5 (1.6) 1.5 (2.1) 1 0.61 .45
Honest 0.5 (0.9) 0.3 (0.8) 1 0.35 .56
Extreme symptomatology
Malingerers 3.7 (2.0) 3.5 (1.9) 1 0.62 .45
Honest 0.9 (1.7) 0.7 (1.2) 1 0.36 .63
Reported versus observed
Malingerers 1.4 (1.2) 0.5 (0.7) 1 1.12 .31
Honest 0.2 (0.4) 0.3 (0.5) 1 0.25 .62
TABLE 4: Utility Analysis of the Miller-Forensic Assessment of Symptoms Test

(M-FAST) (cut score of 6) Across Literacy and Race Groups in Study 2
Utility
Group NPP PPP Specificity Sensitivity FP FN
Literate 0.96 0.69 0.83 0.92 5 1

Illiterate 1.00 0.50 0.83 1.00 1 0
African American 1.00 0.67 0.71 1.00 4 0
Caucasian 0.95 0.50 0.90 0.67 2 1
Note. NPP = negative predictive power; PPP = positive predictive power; FP = false
positives; FN = false negatives.
More specific utility analysis was performed to examine each

group’s performance using the cut score of 6. Table 4 reports the re-
sults of these analyses and indicates similar M-FAST utility. The cut
score of 6 produced five false positives and one false negative for the
literate group and one false positive and one false negative for the
illiterate group.

Utility estimates were conducted comparing the Caucasian (n = 23)

and the African American (n = 22) participants generally by ROC
analyses, ANOVAs, and more specifically, by examining the predic-
tive power of the cut score of 6 for each group. Because there were
only three Hispanic participants, utility estimates do not include this
group (however, all three were correctly classified by the M-FAST
using a cut score of 6). For the Caucasian group, the ROC produced an
AUC of .86 (SE = .10), with a confidence interval of .62 to 1.00. The
ROC for the African American group produced an AUC of 1.00 (SE =
.00). Group differences were also examined by ANOVAs. As Table 5
indicates, no significant differences were found on the M-FAST total
score and four scales between the African American and Caucasian
participants for the malingering and honest responding groups.
More specific utility analyses were performed to examine each
group’s performance using the cut score of 6. Table 4 reports the
results of these analyses and indicates similar M-FAST utility across
race. The cut score of 6 produced four false positives and zero false
negatives for the African American group and two false positives and
one false negative for the Caucasian group.
Utility
Utility estimates were conducted comparing the M-FAST to the

M Test and psychiatrist and psychologist opinions by ROC analyses
and, more specifically, by examining the predictive accuracy of each
group. Figure 6 demonstrates the ROC curves for each group. For the
M-FAST, the ROC analysis produced an AUC of .95 (SE = .03), with a
confidence interval of .88 to 1.00. The ROC for the M Test produced
an AUC of .74 (SE = .07), with a confidence interval of .60 to .87. For
the psychiatrist and psychologist groups, the analyses produced an
AUC of .65 (SE = .09), with a confidence interval of .47 to .83, and
an AUC of .73 (SE = .08), with a confidence interval of .57 to .89,
respectively.
More specific utility analyses were performed to examine the accu-
racy of the measure or clinical opinion. Table 6 reports the result of
this analysis and indicates that the M-FAST produced higher classifi-
cation rates than the M Test or professional opinion.

TABLE 5: ANOVA Results With Miller-Forensic Assessment of Symptoms Test

(M-FAST) Scores and Race for the Malingerers and Honest Respond-
ers in Study 2
African American Caucasian

M-FAST Scale M (SD) M (SD) df F p
Total score
Malingerers 14.3 (4.1) 12.9 (4.9) 1 0.72 .43
Honest 2.9 (3.7) 2.2 (2.8) 1 0.50 .49
Rare combinations
Malingerers 3.6 (1.4) 2.9 (2.3) 1 1.90 .20
Honest 0.6 (0.8) 0.4 (0.8) 1 0.78 .39
Unusual hallucinations
Malingerers 3.1 (1.6) 1.7 (1.5) 1 1.94 .20
Honest 0.9 (1.2) 0.4 (0.6) 1 2.80 .11
Extreme symptomatology
Malingerers 4.0 (1.2) 2.9 (1.7) 1 1.49 .32
Honest 0.9 (1.2) 0.9 (1.3) 1 0.05 .83
Reported versus observed
Malingerers 2.0 (0.9) 1.8 (0.7) 1 0.52 .61
Honest 0.3 (0.5) 0.2 (0.4) 1 0.32 .58
TABLE 6: Utility Analysis Comparing the Miller-Forensic Assessment of Symp-

toms Test (M-FAST) (cut score of 6) With the M Test and Professional
Opinion in Study 2
Utility
Group NPP PPP Specificity Sensitivity FP FN
M-FAST 0.97 0.68 0.83 0.93 6 1

M Test 1.00 0.42 0.47 1.00 19 0
Psychiatrist 0.81 0.50 0.81 0.50 7 7
Psychologist 0.87 0.53 0.75 0.71 9 4
Note. NPP = negative predictive power; PPP = positive predictive power; FP = false
positives; FN = false negatives.
GENERAL DISCUSSION
The existence of a screening measure of malingering may have

substantial utility in all evaluations, particularly in forensic settings
where time and funds may limit the administration of the SIRS to
every client. The M-FAST screen would allow examiners to use a full

ROC – M-FAST ROC – M Test

1.0 1.00
.75 .75
.50
.50
.25
Sensitivity
.25
Sensitivity
0.00
0.0
0.00 .25 .50 .75 1.00
0.00 .25 .50 .75 1.00
1- Specificity
1- Specificity
ROC - Psychiatrists ROC - Psychologists

1.00 1.00
.75
.75
.50
.50
.25
Sensitivity
.25
Sensitivity
0.00
0.00 .25 .50 .75 1.00 0.00
0.00 .25 .50 .75 1.00
1- Specificity
1- Specificity
Figure 6: Receiving Operating Characteristic (ROC) Comparisons Between the

Miller-Forensic Assessment of Symptoms Test (M-FAST), M Test, and
Psychiatrist and Psychologist Opinions in Study 2
malingering assessment on only those who demonstrate high M-

FAST scores. This process may save money and time for several
forensic and nonforensic settings. These analyses extend the previous
validity evidence (Miller, 2001) and indicate that the M-FAST can be
generalized across literate, illiterate, African American, and Cauca-
sian individuals. These studies also suggest that the M-FAST pro-
duces higher classification rates than the M Test or clinical opinion.
Although it has been stated that the structured interview format of
the M-FAST is an advantage of the instrument, this has not been ex-
tensively examined. The interview format was selected in the develop-
ment of the M-FAST to be used in forensic populations where there
are higher incidents of illiteracy and to provide the examiner with
the added behavioral observations that accompany this format. These
analyses alleviate this lack of generalizability and indicate that the M-
FAST works similarly with illiterate and literate individuals. In addi-

tion, similar to the SIRS research results across race (Rogers, 1997b),
the M-FAST appears to generalize to both African American and Cau-
casian individuals. These studies indicate almost identical M-FAST
results for African Americans and Caucasians.
These studies also provide the first evidence comparing actuarial
prediction with the clinical opinion of malingering. Specifically, these
studies compared the M-FAST with the screening procedure gener-
ally used by forensic psychiatrists and psychologists (clinical inter-
views and file review). Although both the psychiatrists and psycholo-
gists in these studies produced accuracy above chance, their rate of
false-negative prediction was most problematic. The psychiatrists in
the sample produced a sensitivity rating of only .50, which translates
into their opinion of malingering missing 50% of the actual malinger-
ers in the sample. The psychologists’ opinions produced a sensitivity
rating of .71, which indicates that they missed 29% of the malingerers
in the sample. In contrast, the M-FAST produced a sensitivity score of
.93, indicating that the screening measure only missed 7% (n = 1) of
the malingerers in the sample.
False-negative prediction in a screening procedure should be mini-
mized, unlike the false-positive prediction where the examiner will
conduct further assessment to determine the malingering diagnosis. It
may be that those individuals who successfully fake mental illness at
the screening stage will never be assessed more specifically for malin-
gering and be considered legitimate patients. This is problematic
because these individuals will likely receive treatment or monetary
gain that should have been provided to a bona fide mentally ill person.
These analyses indicate that using an actuarial malingering screening
measure produces higher classification rates than clinical opinion.
In fact, the M-FAST significantly reduced the rates of false-negative
prediction.
As with any screening measure, the M-FAST should be used as an
initial level of assessment. To make a final diagnosis of malingering, a
thorough evaluation would likely include the SIRS, MMPI-2, or Per-
sonality Assessment Inventory (PAI; Morey, 1991) indicators, clinical
interviews, and collecting collateral information. The final determina-
tion of malingering should not rely on a screening measure but be
deferred until a complete assessment is conducted.

Overall, the reported analyses indicate that the M-FAST can be

generalized to literate, illiterate, African American, and Caucasian
individuals. However, the majority of this evidence is derived from a
sample of 50 males. Thus, further examination of the M-FAST across
literacy, race, and gender is warranted not only with forensic inpatient
psychiatric participants but with other populations as well. In addi-
tion, it is possible, as with all malingering research using known-
groups, that a portion of the psychiatric participants in the malinger-
ing group were mentally ill individuals. It is also possible that the
malingering samples included individuals who were actually men-
tally ill but still attempting to malinger. These individuals are a hybrid
group that, to this date, are very difficult to identify. Thus, it is possible
that some members of the malingering groups in these studies were
mentally ill and simply misdiagnosed by the SIRS or were bona fide
mentally ill and still attempting to malinger to be found incompetent
to stand trial.
NOTE
1. The M Test and Minnesota Multiphasic Personality Inventory-2 (MMPI-2) were given as
part of the initial studies for item selection and validation purposes. These results were reported
in the M-FAST Professional Manual (Miller, 2001).
REFERENCES
American Educational Research Association & American Psychological Association. (1999).

Standards for education and psychological testing. Washington, DC: American Educational
Research Association.
Arbisi, P. A., & Ben-Porath, Y. S. (1995). On MMPI-2 infrequency response scale for use with
psychopathological populations: The Infrequency Psychopathology Scale F(p). Psychologi-
cal Assessment, 7, 424-431.
Beaber, R. J., Marston, A., Michelli, J., & Mills, M. J. (1985). A brief test for measuring malin-
gering in schizophrenic individuals. American Journal of Psychiatry, 142, 1478-1481.
Butcher, J. N., Dahlstrom, W. G., Graham, J. R., Tellegen, A., & Kaemmer, B. (1989). Minnesota
Multiphasic Personality Inventory MMPI-2: Manual for administration and scoring. Medi-
cal Decision Making, 11, 102-106.
Daubert v. Merrell Dow Pharmaceuticals, Inc., 113 S. Ct. 2786 (1993).

Greene, R. (1997). Assessment of malingering and defensiveness by multiscale personality

inventories. In R. Rogers (Ed.), Clinical assessment of malingering and deception (2nd ed.,
pp. 169-207). New York: Guilford.
Guy, L. S., & Miller, H. A. (2004). Screening for malingered psychopathology: Utility of the
Miller-Forensic Assessment of Symptons Test (M-FAST) in a correctional population.
Criminal Justice and Behavior, 31(6), 695-716.
Jackson, R., Rogers, R., & Sewell, K. (2005). Forensic applications of the Miller Forensic
Assessment of Symptoms Test (MFAST): Screening for feigned disorders in competency to
stand trial evaluations. Law & Human Behavior, 29(2), 199-210.
Miller, H. A. (2001). Miller-Forensic Assessment of Symptoms Test (M-FAST): Professional
manual. Odessa, FL: 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.
Miller, H., Guy, L., & Davila, M. (2001, August). The use of the M-FAST with disability claim-
ants. Poster session presented at the American Psychological Association Annual Confer-
ence, San Francisco, California.
Morey, L. C. (1991). Personality Assessment Inventory (PAI): Professional manual. Odessa, FL:
Psychological Assessment Resources.
Rogers, R. (1986). Conducting insanity evaluations. New York: Van Nostrand Reinhold.
Rogers, R. (Ed.). (1997a). Clinical assessment of malingering and deception (2nd ed.). New
York: Guilford.
Rogers, R. (1997b). Structured interviews and dissimulation. In R. Rogers (Ed.), Clinical assess-
ment of malingering and deception (2nd ed., pp. 169-207). New York: Guilford.
Rogers, R., Bagby, R. M., & Dickens, S. E. (1992). Structured Interview of Reported Symptoms
(SIRS) and professional manual. Odessa, FL: Psychological Assessment Resources.
Rogers, R., Salekin, R. T., Sewell, K. W., & Goldstein, A. (1996). A comparison of forensic and
nonforensic malingerers: Prototypical analysis of malingering. Law and Human Behavior,
22(4), 353-367.
Rogers, R., Sewell, K. W., & Goldstein, A. (1994). Explanatory models of malingering: A
prototypical analysis. Law and Human Behavior, 18, 543-552.

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10.

Keywords: M-FAST; malingering; test generalizability; clinical opinion

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Goldstein, 1994). From these data, a routine screen for malingered

The M-FAST was developed as a structured interview primarily

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Another important consideration in the generalizability of the M-

A current debate in forensic psychology and in the legal system is

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opinion that the patient might be malingering, further assessment with

The current analyses examine the generalizability and utility of the

STUDY 1: PRELIMINARY GENERALIZABILITY AND

The sample included 280 psychiatric patients and 13 mental health

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States, who had been determined incompetent to proceed with trial

Miller-Forensic Assessment of Symptoms Test (M-FAST) item pool.

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Structured Interview of Reported Symptoms (SIRS). The SIRS

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Minnesota Multiphasic Personality Inventory-2 (MMPI-2). The

Clinical opinion survey. A clinical opinion survey was developed

The principal investigator or an undergraduate assistant who was

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the primary consideration in the development of the SIRS was to limit

Description of the psychiatric sample is provided in Table 1. One of

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TABLE 1: Description of the Forensic Psychiatric Sample in Study 1

Variable Forensic Psychiatric Sample (N = 280)

Age—Mean (SD) 35 (11)

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produced an AUC of .89 (SE = .02), with a confidence interval of .85 to

STUDY 2: GENERALIZABILITY AND

The sample included 50 psychiatric participants (independent sam-

Instruments and Procedure

This study used identical instruments and procedures as explained

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ROC – Psychiatrist Opinion

ROC – Psychologist Opinion

Diagonal segments produced by ties.

ROC – M-FAST (79 items)

Diagonal segments produced by ties.

Figure 3: Receiving Operating Characteristics (ROC) Comparisons Between

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TABLE 2: Description of the Forensic Psychiatric Sample in Study 2

Demographic Malingerers (n = 14) Honest Responders (n = 36)

Demographic characteristics of the malingerers and honest respond-

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TABLE 3: ANOVA Results With Miller-Forensic Assessment of Symptoms Test

TABLE 4: Utility Analysis of the Miller-Forensic Assessment of Symptoms Test

Literate 0.96 0.69 0.83 0.92 5 1

More specific utility analysis was performed to examine each

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Utility estimates were conducted comparing the Caucasian (n = 23)

Utility estimates were conducted comparing the M-FAST to the

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TABLE 5: ANOVA Results With Miller-Forensic Assessment of Symptoms Test

African American Caucasian

TABLE 6: Utility Analysis Comparing the Miller-Forensic Assessment of Symp-

M-FAST 0.97 0.68 0.83 0.93 6 1

The existence of a screening measure of malingering may have

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