Confabulation: A Review for Forensic ProfessionalsWebinar+2017... · Defining Confabulation “Confabulation, the pathological production of false memories, occurs following a variety

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