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Confabulation:AReviewforForensicProfessionals
Presenter:JerrodBrown,Ph.D.,MA,MS,MS,MS
TreatmentDirectorforPathwaysCounselingCenter,Inc.
TheAmericanInstitutefortheAdvancementofForensicStudies(AIAFS)
ConcordiaUniversity,St.Paul,Minnesota
Presenter’sBiography
JerrodBrown,Ph.D.,MA,MS,MS,MS,istheTreatmentDirectorforPathwaysCounselingCenter,Inc.Pathwaysprovidesprogramsandservicesbenefitingindividualsimpactedbymentalillnessandaddictions.JerrodisalsothefounderandCEOoftheAmericanInstitutefortheAdvancementofForensicStudies(AIAFS),andtheEditor-in-ChiefofForensicScholarsToday(FST)andtheJournalofSpecialPopulations(JSP).Jerrodhascompletedfourseparatemaster’sdegreesandholdsgraduatecertificatesinAutismSpectrumDisorder(ASD),OtherHealthDisabilities(OHD),andTraumatic-BrainInjuries(TBI).JerrodiscertifiedasaYouthFiresetterPrevention/InterventionSpecialist,ThinkingforaChange(T4C)Facilitator,FetalAlcoholSpectrumDisorders(FASD)Trainer,andaProblemGamblingTreatmentProvider.Emailaddress:[email protected]
TrainingObjectives
• Describedifferenttypesofconfabulation(i.e.,spontaneousversusprovoked)anddistinguishtheseconstructsfromotherimportanttopics(e.g.,suggestibility,delusions,andmalingering)thatcanimpactthevalidityofinformationacquiredfromsuspects,witnesses,anddefendants
• Analyzeriskfactorsandwarningsignsforconfabulationincriminaljusticeandforensicsettings
• Describeabasicunderstandingofhowtominimizethelikelihoodofconfabulationduringlegalprocesses
• Describethelatestempiricalfindingsanddiscussdirectionsforfutureresearchonconfabulation
Agenda
• Confabulation:IntroductionandOverview
• CriminalJusticeandForensicConsiderations
• SpecialTopicsofDiscussion
• SpecialPopulations
• ScreeningConsiderations
• InterventionConsiderations
• Conclusion
• SupplementalSlides
MyExperience
• Attachment-RelatedDisorders• AutismSpectrumDisorder(ASD)• CriminalJustice-InvolvedPopulations• FetalAlcoholSpectrumDisorder(FASD)• LearningDisorders
• PersonalityDisorders• SeriousandPersistentMentalIllness(SPMI)• SubstanceAbuseDisorders• SleepDisorders• TraumaticBrainInjury(TBI)• Trauma-RelatedDisorders
Confabulation
DefiningConfabulation
“Confabulation,thepathologicalproductionoffalsememories,occursfollowingavarietyofaetiologies involvingthefrontallobes,andisfrequentlyheldtobe
underpinnedbycombinedmemory andexecutivedeficits”
Turner,Cipolotti,Yousry,&Shallice,2008,pg.637
Confabulation
Confabulationisthecommunicationoffalselyconstructedanswers andinformationbyanindividualrecountingsomethingheorshegenuinelybelievesto
bethetruth (Anastasi,2006)
Confabulationistheactofhonestlylying,providinginformationbasedoninaccuratememorieswhetherthosememorieswereprovoked byquestionsor
arosespontaneously (Moscovitch,1989)
FoundinBrownetal.,2015
InterestingConsideration
“Confabulatorsdispenseworthlessclaimssincerely,whileseemingnottocarethattheyaredisbelieved.Theirclaimsseemvaluabletothem,buttheyareactuallyworthlessbecausetheyweregeneratedbymalfunctioningbrain
processes”
Hirstein,2009,pg.12
ExplainingConfabulation
“Confabulationmayrangefromslightdeviationsinanarrativetonarrativesthathavenofactualbasis”(Brownetal.,2015,pg.1)
“Themechanismsandunderpinningsassociatedwithconfabulationarebelievedtobemultifacetedandcomplex”(Smith&Gudjonsson,1995)
“Whatisknownisthatinsomeinstances,individualswhoconfabulateshownosignsofimpairmentandcanpresentaslogicalandcoherent”(Moscovitch,1995)
FoundinBrownetal.,2015,pg.1
ConfabulationCharacteristics• Verbalstatementsmorecommonthannon-verbalbehavior
• Individualsbelievestheirconfabulatedstatementsareaccurateandarenotlikelytoacceptevidencecontrarytotheiraccounts
• Canpresentascoherentorfantastic
• Canrangefromcompletelyfalsetopartiallytrue
• Personalitymayaffecttheeasewithwhichtheindividualconfabulates
• Peoplemayconfabulateaboutsmalldetailsorfabricateanentireeventthatneveroccurred• Nomotivationtodeceiveormisrepresentthetruth
Moscovitch,1995
Memory&Confabulation
•Memory-relatedmisstatements• Cognitivedeficitsinhigher-ordermemoryprocesses• Organizationaldeficitsassociatedwithmemory• Realityvs.fantasy• Source-monitoringdeficits• Falserecognition• Executivefunctioningdeficits•Memoryloss/gapsinmemory
FalseSelf-Reports-KeyPoint
“Despiteconfusingrealandfictionalevents,falseself-reportsmayholdsomeelementoftruth,whichcancreateanimpressionofaccuratereporting”
Brownetal.,inpress
Confabulation-MyPersonalThoughts
• Complex• Confusing• Fewcriminaljusticeandforensicprofessionalsunderstandthistopic•Majorimplicationsforthecriminaljusticeandmentalhealthsystems•Manymisconceptions•Manygapsintheliterature•Mostlikelyhigheramongcriminaljusticeinvolvedpopulationscomparedtothegeneralpopulation(Researchisneededtoexaminethisclaim)
VariousTypesofConfabulationFoundintheLiterature
• AcuteConfabulatoryPsychosis• AmnesicConfabulatoryBehavior• BehaviorallySpontaneousConfabulations• BizarreandPlausibleConfabulations• ChronologicalConfabulation• ClassicCompensatoryConfabulations• ConfabulatoryEuphoria• ConfabulatoryParaphrenia• ConfabulationsofViolence• DelusionalConfabulation• EmbarrassmentConfabulations• ExoticStoryTelling• Forcedconfabulation• HabitsConfabulations(HCs)• IntrospectiveConfabulations• Memory-RelatedConfabulation
• MomentaryConfabulations• OutofEmbarrassmentConfabulations• PathologicalConfabulation• PerceptualConfabulations• ProductiveConfabulations• ProgressiveConfabulosis• ProvokedConfabulation• PseudologiaFantastica• Recollective Confabulation(RC)• SchizophrenicConfabulations• Self-EnhancingConfabulation• SemanticallyAnomalousConfabulations• SimpleConfabulations• SpontaneousConfabulation• TransientConfabulations• VisualConfabulation
DifficultieswithDefiningConfabulation
Howdowedefineconfabulation?
• Condition• Deficit• Disorder• Distortion• Error• Impairment•MemoryPhenomena• Syndrome• Symptom
PossibleCausesforConfabulationFoundintheLiterature• Impairedmemoryfunction• Executivefunctioningdeficits• Frontallobedamage• Variouscognitiveimpairments• Realitymonitoring/Sourcemonitoringfailures• Autobiographicalmemorydeficits• Preserveasenseofself-identityandself-esteem• Confusion•Memorydistrust• Provokedthroughhighstressinterviews• Amongothers
Biological,emotional,environmental,personal,andsocialfactors
PopulationsPossiblyPronetoConfabulate
• Alzheimer’s• Anton-Babinskisyndrome(unawarenessofblindness)• Aphasia(communicationdisorder-canimpactspeaking,listening,reading,andwriting)• Binswanger'sEncephalopathy• BipolarDisorder• BrainTumors• CerebralDisconnectionSyndromes• CentralNervousSystem(CNS)Infections
• DamagetoFrontalloberegions• Dementia• DorsolateralPrefrontalLesions• Encephalitis• FetalAlcoholSpectrumDisorder(FASD)• FocalFrontalorLimbicLesions• FrontalTumors• FrontotemporalDementia(FTD)• HerpesSimplexEncephalitis
PopulationsPossiblyPronetoConfabulate
•MildLearningDisabilities• NicotinicAcidDeficiency• Hypnosis• Korsakoff’s Syndrome•MedialTemporal(hippocampal)Lesions•MultipleSclerosis• PosteriorCommunicatingArteryAneurysms• PsychoticDisorders
• RupturedACoA aneurysms• Schizophrenia• Split-BrainOperation• SubarachnoidHemorrhage• TraumaticBrainInjury(TBI)• VariantFrontotemporalDementia(bvFTD)•Wernicke-Korsakoff’s Syndrome(WKS)
HowdoesConfabulationPossiblyPresent?
• Absurdstories• Believable• Bizarre• Confident• Confusing• Coherent• Delusional• Detailed• Disorganized• ErroneousStories• Error• Fragmentsoftruememories
• Fairy-tales• ImplausibleStories• Long-term-lesscommon•MisattributetheirWhereabouts• Normal• OutofEmbarrassment• Short-term-morecommon• SubtleDistortions• Unbelievable• UnwittingEmbellishments
Confabulation:OverlappingTerminology
• CloudedConsciousness• Delusionalmemories• DisorderedRecognitionMemory• DisruptedEditingofMemoryTraces• DistortedMemories• Distortionsofmemories• DysfunctionalMemoryProcessing• DysfunctionsofConsciousness• Embellishmentsorelaborations• ErroneousMemories
• ExecutiveRetrievalDysfunction• ExoticStoryTelling• FabricatedMemories• FalseMemories• FalseMemoryRecognition• FalseNarrative• FalsificationofMemory• Faultyencoding• FaultyMemory• FaultyStrategicSearch
Confabulation:OverlappingTerminology
• HonestLying• ImaginationInflation• ImpairedAttentionalControlofWorkingMemory• ImpairedMemoryRetrievalMechanisms• ImpairedTemporalityMonitoring• Impairmentinresponsecriterionadjustmentbasedonmetacognitivefeedback• InappropriateMemories• IntrinsicMemoryPhenomenon• IntrusionErrors• InventedMemories• IrrelevantSpeech• LowMemorySelf-Awareness• MemoryDefect
• MemoryDistortions• MemoryErrors• MemoryFabrications• MemoryFalsification• MemoryFragments• MemoryIllusions• MemoryRetrievalDeficits• MisplacedMemories• Pathological FormsofForgetting• PathologicalMemoryDistortion• PersonalMemoryFailures• ProfoundDisorganization ofMemories• Self-ServingMemoryDistortion• StrategicRetrievalProcessingDeficits
WhataboutFalseMemories?
Falsememoriescanfeel
• Convincing
• Disturbing
• Dramatic
• Emotional
• Real
• Scary
• Vivid
ImportantTopicstobeAwareof
• DRMParadigm
•MisinformationParadigm
• PsychologicalVulnerabilities
• SourceMemory
• Source-MonitoringError
• AutobiographicalMemoryDeficits
•MemoryDistrustSyndrome
DRMParadigm
• JamesDeese-originallydevelopedtheparadigmin1959• RoedigerandMcDermottexpandedonDeese’s researchin1995-Thisiswhenthisapproachbecomemorewidelyknown• Aprocedurethatexaminesandshowshoweasyitistocreateafalsememory• Spontaneouslyinducedfalsememories/falsememoryresearch• Semanticallyrelatedwords(e.g.,awake,bed,blanket,doze,dream,drowsy,nap,peace,rest,slumber,snooze,snore,tired,wake,andyawn)• Criticallure/themewordisomitted(e.g.,sleep)•Whatfactorsinfluencefalsememorycreation?
MisinformationEffect
• Eyewitnessmemory• Post-eventmisinformation•Memorycontamination• Socialinfluence• Sourcecredibility• Suggestivequestioning• Falsememoryproduction
AutobiographicalMemory
•Memoryofself•Who,what,where,andwhenofself• Personalexperiences• Guidesbehaviors• Self-regulation• Self-definition• ToM• Problemsolving
Source-MonitoringError
•Misidentificationoftheoriginalsourceorcontextofthememory• Poormemoryfunctioning• Encodingissues•Memorycontamination• Extremestress• Psychiatricillness• Braindamage• Sleepdeprivation• Suggestiveinfluences• Executivefunctiondeficits
FalseMemoryKeyPoint
“Makingthedetectionoffalsememoryevenharderisthefactthatthefalsememoriesareoftennotcompletelyfalse;theyaredistortionsofthetruth,ablend
oftruthandmemorydistortion,aconfabulation”
Warford&Agharkar,2013,pg.403
MemoryDistrustSyndrome
“Thissyndromecanbedefinedas‘aconditionwherepeopledevelopprofounddistrustoftheirmemoryrecollections,asaresultofwhichtheyareparticularly
susceptibletorelyingonexternalcuesandsuggestions”
Gudjonsson,2003,p.196;Gudjonsson&MacKeith,1982;foundinVanBergen,Jelicic,&Merckelbach,2008,pg.426
MemoryDistrustSyndrome,ConfabulationandFalseConfessions
Gudjonsson,G.(2016).Memorydistrustsyndrome,confabulationandfalseconfession.Cortex.doi:10.1016/j.cortex.2016.06.013.
MemoryDistrust-AnotherResource
Gudjonsson,G.H.,Sigurdsson,J.F.,Sigurdardottir,A.S.,Steinthorsson,H.,&Sigurdardottir,V.M.(2014).Theroleofmemorydistrustincasesofinternalised
falseconfession.AppliedCognitivePsychology,28(3),336-348.
SpontaneousandProvokedConfabulation
SpontaneousConfabulation
“Spontaneousconfabulationsareunprompted andseemtobeinvoluntary.Theyarerelativelyrare,astheymainlymanifestincasesofdementia andmaybethe
resultofaninteractionbetweenfrontallobepathologyandorganicamnesia”(Brownetal.,2016)
Spontaneousconfabulationoccurswhenanindividualcreatesafalsememorywithoutprecipitationbyanexternalforceorinfluence(Schnider,2003;Schnider &Ptak,1999;found
inBrown,2017)
SpontaneousConfabulation-AnExample
ColtheartandTurner(2009)notethatspontaneousconfabulationsoccurwithoutanyrequestforinformationandmayevenbedelusional
Aclientwalkedtoawindow,lookedoutatthestreetandbuildingsbelow,andthenstatedthat,“myboathasbeenstolen”
ColtheartandTurner,2009;foundinHuntley&Brown,2016
ProvokedConfabulation
“Provokedconfabulationreferstoerrorsordistortionsthatareincorporatedintomemoriesinresponsetoanexternalcueorchallenge”(Kopelman,1987)
“Provokedconfabulationoccurswhenthepersonispromptedforananswerorhasreceivedexternalcues,placingtheexpectationforamemorythatdoesnotexistwhile
simultaneouslycommunicatingthatitshouldexist”(Kessels,Kortrijk,Wester,&Nys,2008)
“Becauseprovokedconfabulationresultsfromtheinadequateorincompletesearchforinformationinmemory,fleetingintrusionerrorsordistortionsoftenoccurinresponseto
adirectquery”(Kopelman,2010;Schnider etal.,1996)
FoundinBrownetal.,inpress
ProvokedConfabulation-AnExample
Provokedconfabulationscanoccurwhenindividualsareaskedforsimple“yes”or“no”responses,topointtoapicture(“Doyouseeaphotoofthemanwhorobbed
you?”),ortocreateadrawing
Anexampleofaprovokedconfabulationmightbewhenanemployeestatesthathehadbeenatabusinessmeetinginresponsetoaquestionaboutwhathedidduring
themorning.
Huntley&Brown,2016
ProvokedConfabulation
• Authoritativepositions• Braindamage• Canoccurinhealthysubject• Cross-examination• Explicitlypromptedforaresponse• Intrusionsonmemorytests• Investigativeinterview
•Memory-relatedmisstatements• Notknowingtheanswertoaquestion• Occurinresponsetoanexternalstimulus• Pressuredtorespond• Probingquestions• Producedinresponsetoanexternaltrigger• Responsetoachallenge
Confabulation-AnImportantReminder
• Verbally-Based
• Behaviorally-Based
PossibleMechanismsUnderlyingConfabulation
• BasalForebrainLesions• CognitiveControlFailures• DysfunctionofStrategicRetrievalProcesses• FaultyStrategicSearch• FrontalLobeDysfunction• ImpairedCue-Retrieval•MemoryLoss
• NeurocognitiveDisorders• OrbitofrontalCortexLesions• PrefrontalCortexDamage• PoorExecutiveFunctioning• RealityMonitoringDeficits• Self-EnhancingBiases• Self-MonitoringDeficits• TemporalConfusion
CriminalJusticeandForensicConsiderations
PleaseConsider
“Thebraindamagethatcausesconfabulationcanturnrock-solidprovidersofinformation intopeoplelittlemorereliablethanpathologicalliars”
Hirstein,2009,pg.1
VeryImportantReminder
“Confabulationmayleadtoconvincingfalseconfessionsbecausetheconfabulatorbelievesthattheyaretellingthetruthandwillshownooutwardsignoflying”
foundinBrownetal.,2015,pg.3
ImplicationsforMemoryImpairmentintheCJS
• Defense-relatedinformation• Forgottenappointments• Investigativeinterviews• Cross-examination• Eyewitnesstestimony•MirandaRightsWaiver• Policeline-ups• CompetencytoStandTrial• Probationrequirements• Court-orderedtreatment
Confabulation:ConsiderationsfortheCriminalJusticeSystem
•Maycontributetofalse/inaccuratewitnessaccountsthatcouldleadtowrongfulprosecution
•Maycontributetofalseconfessionsandfalse/incompletealibis
•Maycontributetowrongfulincarceration
•Maycontributetoongoinginvolvementinthecriminaljusticesystem
•Mayinterfere withthedefendant’sabilitytoassistcounsel withhis/herdefense,orpossiblyrenderthedefendantincompetenttostandtrial
Brownetal.,2015
ConfabulationwithintheContextofInterrogation
“Withinthecontextofinterrogation,Gudjonsson(2003a)definesconfabulationas“problemsinmemoryprocessingwherepeoplereplacegapsintheirmemorywithimaginaryexperiencesthattheybelievetobetrue”(p.364).Theconfabulationsin
casesoffalseconfessionstypicallydonotariseinthecontextofneurologicaldisease,butareduetosubtlepsychologicalprocessesinsituationsofhigh
emotionalintensity”
Gudjonsson,Sigurdsson,Sigurdardottir,Steinthorsson,&Sigurdardottir,2014;foundGudjonsson,2016
ConfabulationandReliabilityofTestimony
“Thetendencyofsomepeopletoconfabulateextensivelywhenreportinganeventtheyallegedlysaworheardisrelevanttothereliabilityoftestimony givenby
suspects,victims,andwitnesses”
Gudjonsson&Clare,1995,pg.333
ConfabulationandFalseConfessions
“Thesuspectmayconvertthesimpleadmissionintoafullydetailedconfessioninwhichconfabulationsofmemoryoriginatefromhisorherexposuretosecondhandsourcesofinformation (e.g.,leadingquestions,overheardconversations,crime
scenephotos,andvisitstothecrimescene),oftenfacilitatedbyvariousimaginationalexercises(e.g.,“Thinkhardabouthowyouwouldhavedoneit.”)”
Kassin,2007,pg.176
ConfabulatedFalseConfessions• Acquiescence• Highsuggestibility• Suggestivequestioning• Longinterviewduration• Compliance• Imaginationexercises• Memory-relatedimpairment• Amnesia-relatedcircumstances• Lackofconfidenceintheirownmemories• Generalabsenceofgenuinememories• Neuropsychologicalimpairments• Temporalconfusion
ConfabulationandMalingering
“Confabulationdiffersfrommalingering,inthatmalingeringispurposefuldeviationfromthetruthwithadesiredoutcometoachievesecondarygain (Vitacco,Jackson,Rogers,
Neumann,Miller,&Gabel,2008)
Confabulatorsarenotawareofwhichelementsoftheirrememberedstoriesarerealandwhichhavebeenunconsciouslyinserted(Brownetal.,2015)
Brownet.al,2015,pg.2
ConfabulationwithinCorrectionalSettingsLittleisknownabouttheimpactconfabulationhasonforensicmentalhealth
settings(Smith&Gudjonsson,1995),includingcorrectionalfacilities
Whenaninmateisconfabulatingitmayappeartocorrectionalprofessionalsthattheyarebeingintentionallydeceitful
Thepresenceofconfabulationshouldalertcorrectionalprofessionalstothepossibilitythattheymaybeinteractingwithanindividualwhoiscognitively
impairedand/orvulnerable
IndividualswithaTraumaticBrainInjury(TBI)maybemorelikelytoconfabulateduetomemorydeficitsanddistortionsofrealitycausedbydamagetothebrain
FoundinBrownetal.,2015,pg.3
ASuggestedResource
Brown,J.,etal.,(2015).ConfabulationinCorrectionalSettings:AnExploratoryReview.TheJournalofLawEnforcement,4(3),1-8.
SpecialTopicsofDiscussion
NeurologicalImmaturity
“Neurologicalimmaturityislikelyresponsibleforthefactthatsomeyoungchildrenalsoproducefantasticnarrativesduringinterviews”
Schacter,Kagan,&Leichtman,1995;foundinPoole&Dickinson,2014,pg.403
SocialMediaandConfabulation
Inspirationsforconfabulationcanbedrawnfromsocialmedia
Delusionsvs.Confabulation
Delusionalbehaviorisdescribedasinaccurateand/orfalsebeliefsheldbyanindividualthataremostlikelyillogicalorerroneousinnature (Glowinski,Payman,
&Frencham,2008)
Determiningthedifferencebetweenconfabulationanddelusionalbeliefsshouldinvolvethird-partyinformation(e.g.,examiningtheindividual’sbeliefsystem,lengthoftimethatthedelusion(s)ispresent,andcorroborationbyotherswho
knowtheindividual’shistory)(Brownetal.,2015)
Professionalsshouldalsoattempttomakeadeterminationregardingthevalidityofthedelusionalbeliefs(Brownetal.,2015)
Brownetal.,2015,pg.2
InterestingConsideration
“Hirstein(2005)arguesthatconfabulations,delusions,andthefalsememoriesofhealthyindividualscanbedefinedalongacontinuumofself-deception”
FoundinFotopoulou,2010
Confabulationvs.LyingDiscriminatingbetweenbehaviorsassociatedwithlyingandconfabulationcanbe
extremelychallenging(Glowinski,Payman,&Frencham,2008)
Lyinginvolvesdeceitfulintent,whereasconfabulationisconductedwithouttheconsciousintenttodeceive
Whenattemptingtoidentifyifanindividualisconfabulatingorovertlylying,cliniciansshouldassesswhetherthereisasecondarygain associatedwiththe
statement
Althoughnotalitmustest,assessingsecondarygainsassociatedwithindividualstatementsmayprovidesomelevelofvalidity
FoundinBrownetal.,2015,pg.2
SpecialPopulations
Executivefunctioning
Deficitsinexecutivefunctioningarecommon—difficultiesinproblemsolving,impairedjudgment,poordecision-makingskills,diminishedabilitytocomprehend
thecauseandeffectoftheiractionsandbehaviors
Brownetal.,2015;Zelazo andMuller,2002
Adaptivefunctioning
Adaptivefunctioningisdefinedbyanindividual’sabilitytocareforone’sself andmeetthedemandsofsocialresponsibilities
Aperson’sadaptivefunctioningiscomposedofpractical,social,andmentalcapacitiestodealwitheverydaychallengesandproblems
Harrison & Oakland, 2002
MildLearningDisabilities
“Peoplewithmildlearningdisabilitiestendtoconfabulatemore”
Clare&Gudjonsson,1993foundinSmith&Gudjonsson,1995,pg.517
Clare,I.C.H.,&Gudjonsson,G.H.(1993).Interrogativesuggestibility,confabulation,andacquiescenceinpeoplewithmildlearningdisabilities(mentalhandicap):Implicationsforreliabilityduringpoliceinterrogations.BritishJournalof
ClinicalPsychology,32(3),295-301.
FASD-RelatedDeficits• Impulsivity• Poordecisionmaking• Learningdisabilities• Communicationdeficitsincludingconfusingorinconsistentresponsestoquestioning• Difficultylinkingpastbehaviortoconsequences,whichmaycontributetoanindividualnotrespondingtopunishment• MemoryDifficulties• Mayreadilyfollowothersandarereadilyinfluencedbypeers• Difficultymaintainingfriendships• Difficultywithconceptsofdates,timeandmoney
FASD&Memory
• Confabulation• Executivefunctioningimpairments• Uncertainty• Suggestibility• Socialpressure• Informationprocessingabilitydeficits• Educationandvocationalperformance• Diagnosticassessments
• Memorydemandingtasksandsituations• Workingmemoryproblems• Weakvisualmemoryskills(facememory)• Weakverbalmemoryskills• Poorspatialmemory• Explicitmemorydeficits• CSTevaluations
FASDandConfabulation
“MemoryimpairmentstemmingfromhippocampusdamageandimpairedfrontallobefunctioningisacommondeficitinFASD,causingfreerecalldifficulties
accompaniedbyintrusionsandconfabulation”
Gibbard,Wass,&Clarke,2003;foundinBrown,Gudjonsson,&Connor,2011,pg.45
FASDandFalseConfessions
• Confabulation• Suggestibility• Difficultiesinunderstandinglegalterminology,interviewandinterrogationquestions,andlegalproceedings• Avoidembarrassment• Anattempttopleaseaninterviewer,interrogator,orattorney• Anattempttogetoutoftheoffice/room
Conry &Fast,2000;Williams,2006
FASDandConfabulation
Confusionofeventsmaycauseconfabulationwhenearliermemoriesarejudgedascurrentlyrelevant
Clare&Gudjonsson,2010;Turner&Coltheart,2010;Pedzdek etal.,2009;Fast&Conry,2006
TenTipsForCommunicatingWithAnIndividualWhoMayHaveFASD
1.Usesimple,concreteanddirectlanguage2.Avoidleadingquestions3.Explainthingsslowlytoallowmoretimetoprocesstheinformation4.Asktheindividualtoexplainwhatyousaidintheirownwordstoensureunderstandingofthedirectionorquestion5.Inquireaboutcontactingamentor,advocate,orcaseworkerwhocanoffersupport6.Conducttheconversationinaquietsettingfreeofdistractions7.Givetheindividualspaceandavoidphysicalconfrontation8.Maintainacalmandcollecteddemeanoratalltimes9.Gathercorroboratingevidenceorstatements10.Providefrequentbreakstoprotectagainstdistractionandmentalfatigue
OtherSpecialPopulations
• Schizophrenia
• Traumatic-BrainInjury(TBI)
•Wernicke-Korsakoff Syndrome(WKS)
Schizophrenia&Memory
• Bizarredelusions• Episodicmemorydeficits• Falsememorycreation• Medications• Psychoticsymptoms• Sourcemonitoringfailures• Significantlyimpactoverallqualityoflife
SchizophreniaResource
Shakeel,M.K.,&Docherty,N.M.(2015).Confabulationsinschizophrenia.Cognitiveneuropsychiatry,20(1),1-13.
BrainInjuryBasics
TBIcanbedescribedasachangeinbrainfunctionresultingfromanexternalforce(e.g.,abloworjolttothehard)
Theseverityofsuchanincidentcanvaryfrom“mild”withshort-termalterationsinbrainfunctioningto“severe”withlong-termconsequencesinbrainfunctioning
Menon,Schwab,Wright,&Maas,2010;foundinBrownetal.,inpress
SilentEpidemic
“Traumaticbraininjuryhasbeenreferredtoasthe“silentepidemic,”associetyislargelyunawareofthehighincidencerateandresultingneurocognitivedeficitsthat
accompanythedisturbance”
Langlois &Sattin,2005;foundinBrownetal.,2017
TBI&Confabulation
TBI&Memory
• CanoccureveninmildTBIcases• ExtremelycommondeficitassociatedwithTBI• Substanceuseintoxication• Attentionandconcentrationdeficits• Processingspeeddifficulties• Treatmentcomplianceissues• Consideractsofdomesticviolence• Repeatingthesamewordorphrases• Forwardthinkingmemorydeficits• Problemswithdailylivingskills
WKS
“Wernicke'sencephalopathy(WE)andKorsakoffsyndrome(KS)aregenerallyviewedastwodistinctstagesofthesameillnesscalledWernicke-Korsakoff
syndrome(WKsyndrome)”
Spiegel&Lim,2011
WKS
Wernicke–Korsakoffsyndrome(WKS)isthechronicamnesicstatefollowingWernickeencephalopathy,anacuteneurologicaldisordercharacterizedbyataxia,vestibulardysfunction,nystagmus,drowsinessandaconfusional state(Victoretal.
1989)
Canresultinahostofpathological,neurological,andcognitiveimpairments
Long-lastingorpermanent
Implicationsofthisconditionarewidespread
WKSSignsandSymptoms
• Amnesia• Apatheticandinattentive• Inabilitytoformnewmemories• Severelossofmemory• Lossofmusclecoordination(unsteadyoruncoordinatedwalking)• Confusion• Dementia-likesymptoms• Possibleskinchanges• Hallucinations
• Visionchanges• Doublevision• Eyemovementsabnormalities• Eyeliddrooping• Lossofmusclecoordination• Unsteady,uncoordinatedwalking• Confabulation• Comacanresultinsomecases• Alcoholwithdrawalsymptomsmayalsobepresent
WKS&Memory
• Anterogradeamnesia• Autobiographicalmemoryimpairment• Confusion• Difficultiesinlearningnewinformation• Episodicmemorydeficits• Memoryconsolidation,recall,recognitiondeficits• Memorygaps(confabulation/falsememories)
OverrepresentationofWKSinCertainPopulations
• Homelesspopulations
• Olderindividuals(socialisolation,limitedfamilycontact,limitedresourcesforfood,andalcoholabuse)
• Psychiatricinpatientsettings(alcoholabuseandnutritionaldeficithistories)
• Detoxificationcenters
ImportantReminders
• Mayappearfairlynormalduringbriefinitialencounters• Maybeabletocarryonconversationsnormally• Mayhavenormalintellect• Maybeunabletoidentifyfamilymembersandpeopletheyknewwellfromtheirpast• Maybeunabletoformnewmemories• Mayrepeatthesamethingoverandoveragain• Mayaskthesamequestionsrepeatedly• Mayforgetmeetingyoujustminutesorsecondsearlier• Willmostlikelyrequireconsistentmonitoringandsupervision• Mayrequiretoliveinaninstitutionalizedsetting
EyewitnessTestimonyandKS
“Becauseconfessions andeyewitnesstestimonyareacceptedsoreadilyincriminaljusticesettings,anyinformationprovidedbysomeonewithKorsakoffmaynotbe
accurate”
FoundinBrownetal.,2017
KSandConfabulation
• Damagetothefrontallobes• Sourcemonitoringerrors• Falsememories• Amnesia• Executivefunctiondeficits• Executivecontrolfailure
• Episodicmemory(maydisproportionatelyconfabulate)• Memoryintrusions• Memorydistortions• Memoryerrors• Memoryillusions• Self-monitoringdeficits
SuggestedResource
Borsutzky,S.,Fujiwara,E.,Brand,M.,&Markowitsch,H.J.(2008).ConfabulationsinalcoholicKorsakoffpatients.Neuropsychologia,46(13),3133-3143.
WKSandConfabulationResource
Brown,J.,Fordice,H.,Weaver,J.,&Hesse,M.(2015).Wernicke-KorsakoffSyndromeandConfabulation:AReviewforCriminalJusticeProfessionals.
BehavioralHealth,3(1),1-8.
AnotherHelpfulResource
Huntley,D.,Brown,J.,&Wiley,C.R.(2016).ConfabulationandMentalHealth:ABeginner’sGuide.BehavioralHealth,4(2),1-9
Under-RecognitionofSpecialPopulationsisForensic&LegalSettings
Mayresultinmislabelingormisperceivingthepersonas:• Disorganized• Impulsive• Immature• Lazy• Non-compliant• RemorselessandCallous• Laughingatinappropriatetimes• Indifferent
Behaviorsmaybeadirectresultofimpairmentscausedbythedisability
ImportantRemindersforCriminalJustice&LegalProfessionals
• Certainaccommodationsmayneedtobemade• Intentionalvs.unintentionalbehaviors• Memory• Suggestibility• Confabulation• Vulnerability/victimization• TrialRightDeficits• SentencingandPost-releaseconsiderations
ScreeningConsiderations
ImportantConsideration
“…notcorrectlyidentifyingthepresenceofconfabulationnegativelyimpactsallsubsequentstepsofthecriminaljusticeandlegalprocesses,andmayultimately
leadtofalseconfessionsandinappropriatecourtrulings”
Brownetal.,2014;foundinBrownetal.,inpress
ExaminingHabits
“Individualswhoareatagreaterriskofconfabulatingmayrelyonpasthabitsandmemorieswhenattemptingtofillingapsintheirrecall,overestimatingthelikelihoodthat
theirpastbehaviorisrelevanttothepresent”
Brownetal.,inpress
Imagination
Peoplewhohavebeenaskedtoimaginecompletingasetofmundanetaskswilloftenreportthattheyactuallycompletedthosetaskswhenquestionedlater(Goff&
Roediger,1998)
Thistendencytomistakeimaginationforanactualmemoryisevenstrongerwhenpeopleareshownphotographsofthecompletedworkorareprovidedwith
manipulatedphotographicorvideoevidenceoftheirexperiences(Henkel,2011;Nash&Wade,2009;Wade,Garry,Read,&Lindsay,2002)
Thesefalsememoriesareevenmoreprevalentwhenmultiplesensoryexperiencesareinvolved,suchasbothhearingaboutandimagininganevent(Henkel,Franklin,&Johnson,
2000)
FoundinBrownetal.,inpress
ScreeningConsiderations
Possiblyincludethefollowing:
• ExecutiveFunctioningDeficits
• LanguageDisorders
• LearningDisorders
•MemoryDisorders
• NeurocognitiveDisorders
Whataboutsleepandtrauma-relateddisorders?
SuggestionsforClinicalandForensicProfessionals
• Reviewmultipledatasources(e.g.,multipleaccounts,reviewrecords,etc.)toconfirmaccountsprovidedbyclientswithahistoryofconfabulation•Mayrequireadditionaltestingandpossiblereferralforneurologicalorpsychologicaltesting• Appropriatelydocumentintheindividual’scasefile,whenconfabulationissuspected• Implementfact-checkingprocedurestoclarify andverifystatementsmadebyindividualswithahistoryofconfabulation• Createopportunitiestobetterunderstandtheuniquebehavioralanddevelopmentalcharacteristicsofindividualswithahistoryofconfabulation
AdaptedfromBrownetal.,2015
SuggestionsforClinicalandForensicProfessionals
• Establishpartnershipswithotherprograms,providers,andprofessionalswhounderstandthecomplexitiesofconfabulation
• Expanddiagnosticandintakescreeningprocedures tobetteridentifyclientswhoareatanincreasedrisktoconfabulate
•Developskillsandproceduresforeffectivelyapproachingandcommunicatingwithindividualswhodisplayproblematicbehaviorsassociatedwithconfabulation
•Developandprovideeducationandtrainingopportunitiestoclinicalandforensicmentalhealthprofessionalsregardingthecomplexitiesofconfabulation
AdaptedfromBrownetal.,2015
ClinicalandForensicConsiderations• Amisunderstandingofconfabulationcanleadtoinappropriatecounter-transferenceonthepartofclinicalstaff(Chlebowski,Chung,Alao,&Pies,2009)
•Withinthecontextofclinicalsettings,clinician’sshouldtakeintoaccountconfabulationwhendeterminingtheaccuracyofaclient’sdiagnoses
• Confabulationcanresultinanunreliableself-report,thuscomplicatingthediagnosticassessmentprocess
• Clinicaldecision-makingmaybecompromisedwhenanindividualconsistentlyconfabulates
• Cliniciansmustpaycloseattentiontodiscrepanciesinanindividual’snarrativethatareinconsistentand/orillogical
Smith&Gudjonsson,1995;foundinBrownetal.,2015
ClinicalandForensicConsiderations• Cliniciansarealsoencouragedtoreviewcollateralsourcesofinformation,whenpossible,fromfamilialandnon-familialindividualsfamiliarwiththeindividual’spriordailylivingroutineandfunctioning
• Cliniciansshouldreviewrecordsforbehavioralpatternsthatmayindicateahistoryofconfabulation
• Obtainaccurateandverifiableinformationthroughouttheassessmentandtreatmentprocessisalsostronglysuggested;keepinginmindthatconfabulationmaynegativelyimpactoveralltreatmentoutcomes
DeLuca,1992;DeLuca&Locker,1996;foundinBrownetal.,2015
ConfabulationAssessmentInstruments
•Dalla BarbaConfabulationBattery(DBCB;Dalla Barba,1993)
•ProvokedConfabulationTest(PCT;Cooperetal.,2006)
•TheNijmegen-Venray ConfabulationList(NVCL-20;Rensenetal.,2015)
•PacificAssessmentofConfabulation(PAC)
•TheSacramentoAssessmentofConfabulation(SAC)
TheNijmegen-Venray ConfabulationList(NVCL-20)
Rensen,Y.C.,Oosterman,J.M.,vanDamme,J.E.,Griekspoor,S.I.,Wester,A.J.,Kopelman,M.D.,&Kessels,R.P.(2015).Assessmentof
ConfabulationinPatientswithAlcohol-RelatedCognitiveDisorders:TheNijmegen–Venray ConfabulationList(NVCL-20).TheClinical
Neuropsychologist,29(6),804-823.
InterventionConsiderations
WhatIHaveFoundtoWorkinSomeCases
InterventionConsiderations
• AvoidConfrontation• Diary•MemoryMonitoring• PositiveReinforcement• Self-MonitoringTraining• TreatassociatedSymptoms
Burgess&McNeill,1999;Dayus&vandenBroek,2001;Funayama &Mimura,2008;Glowinski,Payman,&Frencham,2008;Schnider,2001
Interventions-Continued
“Insomuchasconfabulatingpatientssufferfromsomeofthecognitivedeficits,namelyamnesia,executivedysfunction,sourcemonitoringimpairmentsand
strategicretrievaldeficits,themanagementandrehabilitationofconfabulationcanfocusonimprovingthesecognitiveabilitiesandrelatedfunctionalgoals”
Fotopoulou,2008
HowToAddressConfabulationWhenItOccurs
• Corroborateimportantinformationwhenworkingwithindividualswhoarepotentiallyatriskforconfabulation
• Seekoutcollateralinformantsandrecordstoconfirmordisproveself-reportaccounts-(mayincreasetheaccuracyofassessmentandappropriatenessofinterventions)
• Understandthatconfabulationisnotintentional-(willdefinitelybehelpfulinestablishingaworkingrapport)
• Referralforaneuropsychologicalevaluation
Mertz&Brown,2015
Summary-MyOpinion
• Complex• Multifaceted• Confusingattimes• Extremelyimportanttopic• Notontheradarofmanycriminaljusticeandmentalhealthprofessionals• Fewtrainingopportunitiesavailable• Additionalresearchisneeded
BookResources
Questions
ThankYou…
ContactInformation
• JerrodBrown• [email protected]• 651-734-5517• AmericanInstitutefortheAdvancementofForensicStudies(AIAFS)(http://www.aiafs.com/)• AIAFSFacebookPage(https://www.facebook.com/AIAFSeducation?fref=ts)• ForensicScholarsToday(http://online.csp.edu/forensic-scholars-today)• AdultFASDProviderNetwork(https://www.facebook.com/AdultFASDProviderNetwork)
SupplementalResources
ConfabulationSupplementalSlides
ChildWitnessesandConfabulation•DevelopmentalandNeurologicalimmaturity
• Pressuredtoproduceresponsestoquestionsevenifthechilddoesnotproducethecorrectanswer
• Suggestiveinfluencesandquestions
•Maybepushedbeyondtheiractualmemory
•Mayresultinconfabulationormadeupanswers
•Beawareofforcedconfabulation
Ackil &Zaragoza,1998;Poole&Dickinson,2014;Stolzenberg&Pezdek,2013
ForcedConfabulationandForensicInterviews
“Forcedconfabulationcanoccurinforensicinterviewswhenaninterviewerpressesaneyewitnesstoansweraquestioneventhoughtheeyewitnesshasindicatedthatheorshedoesnotknoworisunsureoftheanswertothequestion”(Stolzenberg
&Pezdek,2013,pg.78)
Stolzenberg,S.,&Pezdek,K.(2013).Interviewingchildwitnesses:Theeffectofforcedconfabulationoneventmemory.Journalofexperimentalchildpsychology,
114(1),77-88.
PreschoolChildren
“Preschoolchildrentendtoreportandbehaveasthoughtheyhadknownnovelfactsforalongtime,eventhoughtheyhadactuallyacquiredthemonlyminutes
earlier”
Taylor,Ebensen,&Bennett,1994;foundinAsp&Tranel,2013,pg.398
HistoryofConfabulation
Confabulation-AHistoricalDefinition
“Confabulationisafactuallyincorrectverbalstatementornarrative,exclusiveofintentionalfalsification,fantasticfabrication,randomguesses,intrinsicnon-sense,thechaoticthemesofdeliriumandhallucinations,andallsystematicdelusions
otherthanthosearisingfromthepatient’sdisorientationinhisexperiencedtime”
Talland,1961,pg.366;foundinSchneider,2008,pg.49
HistoryofConfabulation• “Theword[confabulate]datesbackasearlyas1450,andinitsoriginalusage,meant:totalkfamiliarlytogether,converse,chat.’”(Berrios,1998;Hirstein,2005;OxfordEnglishDictionary,2ndEdition)
• “Earlyresearchers…proposedthatconfabulationreflectsadesiretofillingapsinmemory,termed‘confabulationoutofembarrassment.’”(Bonhoeffer,1901;VanDerHorst,1932;Schnider,2008)
• Confabulation,asatechnicalterm,wasfirstappliedtoKorsakoff’s patientsbytheGermanpsychiatristKarlBonhoefferintheearly1900s(Berrios,1998;foundinBrownetal.,2015,pg.1)
Chrobak &Zaragoza,2009;foundinHirstein2009,pg.86;Fotopoulou,2009;foundinHirstein,2009,pg.263;DeLuca,2009;foundinHirstein,2009,pg.21-22
HistoricalAccountsofConfabulation
PerhapstheearliestclinicaldescriptionofspontaneousconfabulationwasfromtheseminalobservationsofthefrontallesionpatientPhineasGagebyHarlow(1868/1993),whonotedthat“(Gage)wasaccustomedtoentertainhislittle
nephewandnieceswiththemostfabulousrecitalsofwonderfulfeatsandhairbreadthescapes,withoutanyfoundationexceptinhisfancy"(p.277).
FoundinAsp&Tranel,2013,pg.397
HistoricalReference
Mercer,Wapner,GardnerandBenson(1977),intheirstudyof11amnesicpatients,arguedthatconfabulationisinfluencedby:
(a) impairedmemoryfunctionleadingtouncertainty
(b) thebeliefthataresponseisexpected
(c) theavailabilityofanoverlearnedoraffectivelysignificantresponse
(d) impairedabilitytomonitororselfcorrectresponses
FoundinSmith&Gudjonsson,1995,pg.517
EarlierResearchonConfabulation
“Earlieraccountsputforwardproposedthatconfabulationswerebasedonthepsychologicalneedto‘fillin’embarrassingmemorygaps,satisfythesuggestions
oftheexaminer,ordenythepainfulrealityofbraindamage”
Berlyne,1972;Whitlock,1981;Weinstein,1996;Weinstein&Kahn,1955;foundinFotopoulou,Conway,Solms,Tyrer,&Kopelman,2008,pg.1430
HistoricalConsideration-ConfabulationsofViolence
Weinsteinandcolleagues(1956)claimedconfabulationsofviolencewerecommoninpatientswithheadinjury,andtheymaycontainsymbolicrepresentationsoftheir
currentpreoccupationsanddisabilities