Law and Human Behavior, Vol. 16, No.

3, 1992

Forensic Neuropsychology and the

Criminal Law*

Daniel A. Martellt

This article explores theoretical and empirical issues in the application of clinical neuropsychological
evidence to forensic issues in the criminal law. The nature of forensic neuropsychological evaluations
is discussed with reference to issues of competency to stand trial, criminal responsibility, and other
competencies in the criminal process. Examples of specific disorders relevant to criminal law stan-
dards are presented, together with data estimating the prevalence of brain dysfunction in criminal and
forensic populations. Research is also reviewed on the role of neuropsychological brain dysfunction in
the etiology of violence and criminally relevant behavior. Finally, empirical and ethical issues con-
cerning the applicability and admissibility of forensic neuropsychological data in the criminal context
are discussed.

This article examines the evidentiary value of forensic neuropsychological testi-

mony to inform judicial decision making in the context of the criminal law. Fo-
rensic neuropsychology, broadly defined, involves the application of clinical
neuropsychological assessment to legal issues (Gilandas & Touyz, 1983; Golden
& Strider, 1986; McMahon, 1983). To date, its role has evolved almost exclusively
in the realm of the civil law, given its relevance to issues in disability determina-
tion, workman's compensation, and personal injury cases (Anchor et al., 1985;
Mack, 1980). This emphasis on civil law is reflected in the literature introducing
lawyers to the potential contributions of neuropsychologists (Anchor, Rogers,

* An earlier versions of this article was presented at the biannual meeting of the American Psychol-
ogy-Law Society, March, 1988 in Miami, Florida. Many thanks to Jeff Barth, Park Dietz, Joel
Dvoskin, Steve Golding, Daryl Matthews, and two anonymous reviewers for helpful comments on
earlier drafts of this article. Thanks to Jessica Greenwald and Shira Sanders for additional editorial
assistance. Address all correspondence to Daniel A. Martell, Forensic Neuropsychology Labora-
tory, Kirby Forensic Psychiatric Center, Ward's Island, NY 10035.
t Forensic Neuropsychology Laboratory, Kirby Forensic Psychiatric Center, and Nathan S. Kline
Institute for Psychiatric Research, New York University School of Medicine.
313

0147-7307/92/0600-0313506.50/0 9 1992 Plenum Publishing Corporation

314 MARTELL

Solomon, Barth, & Peacock, 1983; Incagnoli, 1985; Pierce, 1985; Whelihan &
Ivans, 1981), as well as literature directed at neuropsychologists to outline their
participation in the legal arena (Bigler, 1986; Gilandas & Touyz, 1982; Golden &
Strider, 1986; Kurlychek, 1984). Consequently, there is very little scholarship
regarding potential applications of neuropsychology to issues in the criminal law.
What little treatment there is of criminal-legal issues in the literature on
forensic neuropsychology has been superficial. A few sources acknowledge the
potential relevance of neuropsychology to issues in criminal law, but either do not
pursue those issues in detail (e.g., Gilandas & Touyz, 1983; Golden & Strider,
1986), or dismiss them as too infrequent to warrant serious attention (McMahon
& Satz, 1981). Only three references touch on criminal-legal neuropsychology in
any greater detail. Anchor et al. (1985) comment briefly on neuropsychological
evaluations in competency to stand trial and criminal responsibility determina-
tions; Hall and McNinch (1988) begin to examine the role of frontal lobe impair-
ment as it relates to issues of criminal responsibility; and a chapter by Schuster
(1989) includes two criminal case examples.
The present article provides a closer examination of this largely unexplored
area by considering forensic neuropsychology as it relates to issues arising in the
criminal law. After examining components essential to competent forensic neuro-
psychological assessment, this article will focus on the application of neuropsy-
chological evidence to specific psycholegal issues in the criminal process. These
will include evaluation of (a) competency to stand trial, particularly in the eval-
uation of potential for restoration of fitness to proceed (pursuant to Jackson v.
Indiana, 1972); (b) criminal responsibility, diminished capacities, and the insanity
defense; and (c) related competencies specific to the criminal process. Examples
of neurobehavioral disorders are used to illustrate their implications for these
issues. Finally, empirical and ethical issues relating to the admissibility of neuro-
psychological evidence are presented.

W h y Neuropsychology?
Advances in clinical neuroimaging and emerging evidence of significant levels
of brain dysfunction in forensic populations foreshadow a larger role for the
neurobehavioral sciences in the criminal law (Martell, 1992; Tancredi & Volkow,
1988). Clinical neuropsychology, but virtue of its unique ability to characterize the
objective psychological, behavioral, and emotional consequences of abnormal
brain conditions, has the potential to play an increasingly important role in the
criminal courtroom.
Traditionally, clinical psychology and the law have come together around
issues of major mental illness: Does the defendant suffer from a mental "disease"
or "defect," and if so, what is its impact on his or her behavior relevant to the
requirements of the law? In this context, concern has centered almost exclusively
on psychosis, as the expense of other potentially relevant sequelae of brain dys-
function. Many neuropsychological disorders raise largely unexplored issues that
diverge from the traditional concern with psychosis, yet have important implica-
tions for criminal-legal standards of behavior. Most of these disorders fall clearly
NEUROPSYCHOLOGY AND CRIMINAL LAW 315

within the scope of "mental disease or defect" language. For example, they
encompass mental "disease" when we consider neoplastic disease (brain tumors),
cerebrovascular disease, or progressive degenerative dementias (e.g., Alzhei-
mer's disease, AIDS-Dementia Complex). Similarly, they encompass "defect" in
the form of acquired head injuries, perinatal brain abnormalities, neurodevelop-
mental anomalies, and mental retardation. Such "organic" brain disorders may or
may not result in psychosis, yet many result in memory, language, cognitive,
and/or behavioral impairments with significant implications for criminal-legal
standards of behavior. Among neurobehavioral scientists, neuropsychologists
routinely address the cognitive, behavioral, and emotional sequelae of brain dam-
age or cerebral dysfunction at a level adequate to inform judicial decisions in the
presence of organic brain disease or defect.
Simultaneously, the distinction between "organic" and "functional" mental
disorders is no longer so clear. Recent tomographic studies (reviewed by Raz &
Raz, 1990) document the presence of structural brain abnormalities in those major
psychotic disorders most often associated with incompetency and/or insanity in
the criminal law (i.e., schizophrenia and affective psychoses). This kind of evi-
dence is becoming so pervasive that Spitzer, Williams, First, and Kendler (1990)
have proposed eliminating the term organic from the DSM-IV altogether, to re-
flect the view that all mental illness may have some basis in brain abnormality.
Consequently, the growing behavioral science concern with brain status and men-
tal disorder is likely to be reflected in the increasing introduction of neuroscien-
tific evidence in criminal proceedings (Tancredi & Volkow, 1988).

Neuropsychological Evidence
The particular appeal of neuropsychological evidence in the criminal context
is the expert's ability to bring quantified, normative data on brain-behavior rela-
tionships to bear in support of what have traditionally been professional opinions
based on mental status examinations and clinical interview techniques. While
psychological data about mental functioning are not the exclusive domain of the
neuropsychologist, neuropsychological assessment generally addresses brain-
behavior relationships in greater depth and with greater behavioral specificity
than other areas of psychology. The ability to provide the trier of fact with a
normative description of a defendant's neurobehavioral strengths and weaknesses
can bring important new information to the criminal decision-making process.
Equally relevant to criminal law issues is the ability of neuropsychological
assessment to relate the presence of structural and functional brain abnormalities
to changes in individual behavior (Boll, 1985; Heaton & Pendleton, 198 I; Jarvis &
Barth, 1984). In the criminal context it is not enough simply to show that the
defendant has a brain lesion, just as the de facto presence of a major mental illness
alone does not render a defendant incompetent or insane. Rather, the behavioral
consequences of the lesion are central to the concerns of the law. In this regard,
neuropsychology enjoys a distinct advantage over traditional medical testimony
regarding evidence of brain damage. While emerging neuroimaging technologies
such as Computerized Axial Tomography (CAT), Positron Emission Tomography
316 MARTELL

(PET), and Magnetic Resonance Imaging (MRI) permit very specific evidence
regarding the presence and nature of brain lesions, they reveal little or nothing of
the behavioral consequences of the lesion in terms of level of impairment across
cognitive, emotional, and behavioral spheres (Boll, 1985). Most medical opinions,
beyond verifying the presence and location of the lesion, ultimately resort to
informed speculation when it comes to relating the lesion to the behavior of the
defendant in a specific case. This is why a referral for neuropsychological assess-
ment is often made in clinical settings, and why it is relevant to criminal law:
neuropsychology assesses the impact of a brain lesion on behavior and mental
functioning.
Studies have documented the sensitivity of neuropsychological assessment to
detect subtle abnormalities in brain function that may go undetected even by the
most sophisticated medical/neurological techniques (Barth, Gideon, Sciara, Hul-
sey, & Anchor, 1986). Neuropsychological test batteries have been shown to be
equivalent or superior to traditional neurodiagnostic techniques (including phys-
ical neurological examination, EEG, pneumoencephalography, angiogram, x-ray,
and CAT scan) in detecting both the presence and general location of brain dam-
age (Boll, 1978; Filskov & Goldstein, 1974; Tsushima & Wedding, 1979). This
capability to reliably detect brain abnormality is important to establishing the
presence of "mental disease or defect." However, clinical neuropsychology's
greater strength lies in its descriptive ability to correlate evidence of brain abnor-
mality with behavioral changes and outcomes with implications for the subject's
everyday level of functioning (Heaton & Pendleton, 1981). Its sensitivity for de-
tection and behavioral description make neuropsychological assessment espe-
cially useful when used to amplify or clarify findings from medical/neurological
techniques, documenting the consequences of brain lesions for the individual's
levels of functioning.
The capability to relate a known brain lesion to the capacities of a defendant
relevant to several legal standards of behavior sets clinical neuropsychology apart
from medical/neurological testimony, and ultimately makes it of direct relevance
to the issues facing the trier of fact. While research advances (especially in the
application of neuropsychological data to forensic issues) will help the field to
fully realize this potential, the argument can already be made that the current state
of the art permits valid opinions to be offered that are immediately relevant to
criminal/forensic issues. Even Ziskin and Faust (1988), who have been criticized
for their one-sided portrayal of the inadequacies of psychiatric and psychological
testimony (cf. Brodsky, 1989; Matarazzo, 1990), endorse neuropsychology as an
area with potential to inform legal decision making. Despite reservations regard-
ing the state of the art as it stood in the mid-1980s, they assert, "Overall, in our
opinion, the field of neuropsychology shows substantial promise, and the quality
of research and method are often a cut above that seen in many other areas of
clinical psychology and psychiatry" (19. 784).
However, this remains an important area for future research. Good studies on
which to base opinions about the relationship between neuropsychological test
performance and activities of daily life are few (Boll, 1985; Heaton & Pendelton,
1981). The need for greater ecological validity is one of the major challenges
NEUROPSYCHOLOGY AND CRIMINAL LAW 317

currently facing the field (Franzen, 1989; Heinrichs, 1990), and this is especially
true for criminal/forensic applications of neuropsychology (see Konecni & Ebbe-
son, 1979). While mainstream neuropsychological research has been investigating
relationships between test scores and activities of daily living and work perfor-
mance (cf. Butler, Anderson, Furst, Namerow, & Satz, 1989; Heaton & Pendel-
ton, 1981; Matarazzo, 1972), more attention needs to be paid to their relationship
with criminal-legal standards of behavior.
Forensic Neuropsychological Assessment
Clinical neuropsychology, the study of brain-behavior relationships, is rela-
tively new as a unique area of psychological inquiry, although research in the area
has been ongoing since the 1940s (Lezak, 1983). It is currently one of the most
rapidly developing subareas of psychology. It is also a field in which much re-
search remains to be done. This is especially true with regard to the forensic
applications of neuropsychology.
The very best neuropsychological assessments represent the highest level of
contemporary objective psychological evaluation. A variety of mechanical, ob-
servational, and paper and pencil tests are generally employed to assess brain
integrity and to describe behavioral strengths and weaknesses associated with
pathological brain conditions. Integrating data from tests of specific neurobehav-
ioral abilities with those from achievement, intelligence, and personality mea-
sures, the neuropsychologist can arrive at a fairly comprehensive picture of an
individual's level of cognitive, emotional, and behavioral functioning. These data
are then evaluated in the context of the subject's history (education, employment,
highest level of "premorbid" functioning), previous testing, and medical findings
(e.g., results of neurological examination, brain scans, etc.) to assess the nature
and extent of brain-behavior strengths and weaknesses.
Brain damage is not a unitary construct; there are many forms of brain dam-
age that may arise from very different causes. Hence no single test is adequate for
the detection or diagnosis of brain damage (Boll, 1978, Jarvis & Barth, 1984).
Typical neuropsychological evaluations include a comprehensive battery of as-
sessment techniques. The Halstead-Reitan Neuropsychological Battery (HRNB:
Boll, 1981; Reitan & Wolfson, 1985) and the Luria-Nebraska Neuropsychologicat
Battery (LNNB: Golden, 1981) are the most prominent standardized techniques.
Boll (1978, 1985) and Golden (1986) present detailed accounts of the research data
supporting the reliability and validity of the Halstead-Reitan and Luria batteries,
respectively. Kane, Parsons, and Goldstein (1985) have demonstrated the com-
parability of these two test batteries with regard to diagnostic screening accuracy,
and evaluation of the level of impairment.
There are also a number of specialized tests for specific neuropsychological
functions, many described in detail by Lezak (1983) and Spreen and Strauss
(1991), that may be used in conjunction with one of the aforementioned batteries,
or combined independently to form a unique battery. This latter technique, some-
times referred to as the process/qualitative (Kaplan, 1990) or hypothesis-testing
approach to neuropsychological assessment, tailors an ideographic battery of se-
lected tests to the demands of an individual case.
318 MARTELL

Regardless of the battery of tests selected, functional areas of interest central

to all neuropsychological assessments generally include (a) intelligence, (b) atten-
tion and orientation, (c) sensory-perceptual functioning, (d) pure motor function-
ing and control, (e) visual-motor integration, (f) learning and memory (verbal and
visual, immediate, short term, and long term), (g) language functioning, and (h)
higher integrative cognitive functions including the executive control (i.e., plan-
ning and organization) of behavior, abstract reasoning, and problem-solving. Neu-
ropsychologists also routinely assess educational achievement and personality
functioning. Principles of neuropsychological assessment are discussed in much
greater detail by Lezak (1983).
The practice of forensic neuropsychology demands the highest standards of
thoroughness, accuracy, and care in the administration, scoring, interpretation,
and reporting of findings. The general comparability of the available test batteries
(Kane et al., 1985) makes the choice of a battery less important than meticulous
attention to norms. Often, the forensic issue may require additional testing be-
yond a standard battery to more thoroughly address the psycholegal issues or to
more completely describe the defendant's strengths or disabilities. Supplementa-
tion of the standard battery is common in clinical practice (Jarvis & Barth, 1984),
and should be encouraged in forensic neuropsychological assessment. However,
it is extremely important that the clinician select supplemental tests with well-
documented norms, adjusted where appropriate for age and education, and po-
tential racial, ethnic, or cultural bias (Bernard, 1989; Franzen, 1989; Heaton,
Grant, & Matthews, 1991; Leckliter & Matarazzo, 1989; Matarazzo, 1990; Spreen
& Strauss, 1991). Only then can it speak adequately to the presence or absence of
mental disease or defect, and its relationship to specific criminal-legal referral
issues.
An increasingly important area of neuropsychological evaluation (with direct
relevance to forensic applications) is the assessment of attempts to malinger,
simulate, or exaggerate brain dysfunction. However, this is a controversial area
within neuropsychology because of limitations in study designs and the interpre-
tation of research findings. Studies of the ability of neuropsychologists to detect
malingering have fallen on both sides. Faust, Hart, Guilmette, and Arkes (1988)
have questioned the ability of neuropsychologists to detect adolescents told to
malinger neuropsychological deficits. However, Bigler (1990) notes several prob-
lems with the design of the Faust study that cast serious doubt on the validity of
their findings. Other studies using adult populations have affirmed the ability of
neuropsychologists to discriminate between true and malingered test performance
above chance levels, including studies using data from the Halstead-Reitan
(Goebel, 1983; Heaton, Smith, Lehman, & Vogt, 1978) and Luria-Nebraska
(Mench, 1984) neuropsychological test batteries. However, there are also argu-
ments over the methodological strengths and weaknesses of these studies (cf.
Faust et al., 1988; Guilmette & Giuliano, 1991; Pankratz, 1988).
One of the major methodological problems with the literature on neuropsy-
chology and malingering is that none of the studies have incorporated specialized
tests that have been developed to help detect efforts to simulate neuropsycholog-
ical impairments (Binder & Pankratz, 1987; Lezak, 1983; Pankratz, 1988; Wasyliw
NEUROPSYCHOLOGY AND CRIMINAL LAW 319

& Cavanaugh, 1989). Rather, they generally have relied on standard test scores
alone, often in the absence of adequate background information regarding the
referral issue or presenting problem. A number of these specialized clinical tech-
niques have been developed, and are advocated for forensic use. It is critical that
any forensic neuropsychological evaluation include as many of these specialized
techniques as possible. Although the definitive study has yet to be conducted,
there is evidence for the utility of each of these techniques (Lezak, 1983; Pank-
ratz, 1988). When considered in the context of an individual's performance on a
standard battery, these techniques may significantly increase the ability to detect
simulators. Even lacking a definitive research study, neuropsychological testi-
mony will be more credible if the clinician has clearly taken this issue into account
and incorporated these techniques to assess it.

Relating Neuropsychological Impairment to Legally Relevant Behavior:

Base Rates and Research Findings
The ecological validity of neuropsychological evidence is enhanced if it can
be shown that brain impairment is associated with behaviors relevant to criminal
law. In this regard, it is useful to consider (a) the ways in which neuropsycho-
logical impairment interferes with the defendant's ability to participate in various
criminal procedures (i.e., criminal competencies); and (b) ways in which it con-
tributes to the causation of criminal behavior (which goes to issues of criminal
responsibility). This section begins with a review of research on the prevalence of
neuropsychological disorders in criminal and forensic populations. Because brain
damage can have significant implications for both criminal competencies and
criminal behavior, knowledge of the prevalence of brain dysfunction provides an
estimate of the scope of the problem. Then, studies that associate neuropsycho-
logical impairment with violence and criminal behavior will be reviewed.

Base Rates of Brain Impairment in Forensic Populations

The lack of base rates for neuropsychological disorders is a significant prob-
lem across all clinical settings (Duncan & Snow, 1987), and this is particularly true
in forensic settings. However, recent epidemiological studies are beginning to
provide estimates of the prevalence of abnormal brain conditions in various fo-
rensic populations.
Clues to the prevalence of brain disorders among mentally disordered offend-
ers come from three diagnostic census studies. Odejide (1981) studied "criminal
lunatics" at the Lantoro Psychiatric Institution in Nigeria. His data show that
24.6% of the subjects were either epileptic (18.9%) or suffered from organic psy-
choses (5.7%). Hfifner and Brker (1982) conducted an epidemiological diagnostic
study of 533 mentally disordered offenders entering the forensic mental health
system in the Federal Republic of Germany over a 10-year period. Their data
suggest that 33.6% of these patients had a diagnosis reflecting organic cerebral
impairment. These included mental retardation (12.7%), late-acquired brain dam-
age (8%), cerebral atrophy (7.5%), and epilepsy (5.4%).
320 MARTELL

Martell (1992) presents data from 50 randomly selected American forensic

patients retained in a maximum-security state hospital for mentally disordered
offenders in New York. Multiple indicators of potential brain dysfunction were
present in 66% of these cases, with at least one indicator present in 84% of the
subjects. The presence of certain brain disorders was significantly associated with
indictments for violent crimes in this sample. Specific findings included a history
of severe head injury with loss of consciousness (22%), seizure activity (8%),
evidence of cognitive impairment (18%), abnormal neurological findings (75%),
and abnormal neuropsychological or neurodiagnostic findings (32%).
Other studies have examined brain impairment in jail and prison populations
(Monroe, 1981). Neighbors (1987) conducted a psychiatric epidemiologic study of
1000 prisoners randomly selected from the total prison population in the state of
Michigan. Both the Diagnostic Interview Schedule (DIS) and the Structured Clin-
ical Interview for DSM-III-R (SCID) were used to establish lifetime prevalence
(DIS) and current primary diagnosis (SCID). His data suggest that 8.2% of the
prison population meet research diagnostic criteria for organic brain disorders
(5.3% with Organic Brain Syndrome/Cognitive Impairment and 2.9% with Organic
Personality Disorder--Explosive type). However, structured diagnostic inter-
views are not terribly sensitive instruments for the detection or diagnosis of ab-
normal brain functioning, hence these findings probably underestimate the extent
of brain dysfunction in the population.
Studies using neuropsychological test batteries suggest much higher levels of
brain impairment. Yeudall and From-Auch (1979) document varying patterns of
abnormal HRNB findings in numerous forensic populations, including adolescent
delinquents, forensic psychiatric patients, aggressive psychopaths, sex offenders,
and violent criminals. Among adult criminals, Yeudall (1977) reports abnormal
HRNB findings in 90% of his sample, including 100% of rapists, 94% of homicide
offenders, and 87% of assaultists. Lewis and her colleagues conducted uncon-
trolled, descriptive studies of both juvenile and adult prisoners on death row
(Lewis et al., 1988; Lewis, Pincus, Feldman, Jackson, & Bard, 1986). These
studies documented significant brain dysfunction in the majority of these subjects,
including neuropsychological impairment on the HRNB, histories of head injury,
neurological impairment, and cognitive deficits. If confirmed in controlled stud-
ies, these findings would have important implications for issues of competency to
be executed, as well as ways in which biological bases of violent behavior will be
viewed in the criminal justice system in coming years.

Neuropsychological Impairment and Violent Crime

Brain damage can impact the entire range of human behavior. However, its
relationship to criminal behavior often springs from some combination of disin-
hibition, impaired social judgment, hypersexuality, aggression, and/or violence.
Of these, research linking brain dysfunction to aggression and violence is perhaps
the most developed relative to criminal-legal standards of behavior (Volavka,
Martell, & Convit, 1992).
Theoretical models emerging from neuropsychology (Gorenstein & Newman,
NEUROPSYCHOLOGY AND CRIMINAL LAW 321

1980; Yeudall, Fedora, & Fromm, 1987) and neurology (Tancredi & Volkow,
1988; Weiger & Bear, 1988) suggest that brain damage increases the risk of violent
behavior. Abnormal brain functioning may impair inhibition of violent impulses,
and/or stimulate excesses in impulsivity and behavioral dyscontrol. Either mech-
anism may increase an individual's propensity to aggressive or violent behavior,
particularly in combination with other characterological, environmental, or situ-
ational risk factors. Researchers have begun to document the importance of sev-
eral specific types of brain impairment in violent behavior, including head injury,
mental retardation, frontal and temporal lobe dysfunction, seizure disorder, and
neurological abnormalities (cf. Langevin, Ben-Aron, Wortzman, Dickey, &
Handy, 1987; Martell, 1992; Nachshon & Denno, 1987; Silver & Yudofsky,
1987).
Neuropsychological studies of brain function in violent groups have yielded
significant support for theories that associate violent behavior with brain dysfunc-
tion (Pontius & Yudowitz 1980; Spellacy, 1977, 1978; West, 1981). For example,
Bryant, Scott, Golden, and Tori (1984) found a significant relationship between
learning disability, neuropsychological deficits, and violent criminal behavior.
Impaired scores on subscales of the Wechsler Adult Intelligence Scale have also
been associated with violent behavior (Dieker, 1973; Kunce, Ryan, & Eckelman,
1976). Programmatic studies by Yeudall and his colleagues (Yeudall & Fromm-
Auch, 1979) have documented significant neuropsychological deficits in both vi-
olent prisoners and forensic psychiatric patients.
Other neuropsychologists have also demonstrated the ability of neuropsy-
chological findings to discriminate between violent and nonviolent offenders
(Spellacy, 1978; West, 1981). Patterns of impairment on the HRNB consistently
discriminate juvenile delinquents from matched controls (Berman & Siegal, 1976;
Spellacy, 1977; Yeudall, From-Auch, & Davies, 1982). Studies using the HRNB
have also reported significant differences in the neurospychological performance
of psychopathic and nonpsychopathic criminals (Fedora & Fedora, 1983), sug-
gesting greater impairment of dominant (left) hemisphere function among criminal
psychopaths (see also Hare & McPherson, 1984; Jutai & Hare, 1983). Langevin et
al. (1987) used both the LNNB and the HRNB in a study comparing murderers,
other violent offenders, and nonviolent controls. They found that while the
LNNB did not discriminate among these groups, the HRNB did detect significant
differences, with killers and assaulters showing greater levels of impairment than
controls on several of the subtests. Taken together, this literature suggests that
neuropsychological impairment may play a significant role in the criminal behav-
ior of certain offenders. However, the nature and extent of this role, and its
interaction with other personal environmental and situational risk factors remains
to be determined.

Neuropsychological Evidence in the Criminal Context

A significant controversy exists over the propriety of behavioral science
experts providing opinions that address directly the ultimate issue before the court
in criminal matters (Rogers & Ewing, 1989). The value of neuropsychological
322 MARTELL

evidence lies in its ability to provide the trier-of-fact with objective data that
illuminates the substantive questions that underlie the ultimate issues. Hence,
proper neuropsychological testimony should not address ultimate legal issues
directly.
In discussing the "ultimate issue issue," Slobogin (1989) makes the distinc-
tion between penultimate language--words reflecting the substance of the legal
test--and the ultimate issues themselves. Ultimate issues of insanity and incom-
petency are uniquely legal concepts whose ultimate determination properly lies
with the trier-of-fact. However, Slobogin argues that expert evidence that clarifies
the legal language underlying the ultimate issues is the proper domain of the
behavioral science expert. "Legal tests often contain language that is meaningful
to mental health professional in the expert role. My view, contrary to the ABA's,
is that so long as a term has clinical content, the fact that it has been given specific
legal meaning should not prevent it from being used by the clinician" (Slobogin,
1990, p. 263). Emphasis should be placed on providing the court with data that go
directly to the penultimate language, and help to inform the court in its deliber-
ations regarding the ultimate issues at hand. Assuming Slobogin's philosophical
position, the following section of this article will explore some of the legal lan-
guage that sets the stage for expert neuropsychological evidence.

Competency to Stand Trial

The behavioral standards underlying findings of competency to stand trial
spring primarily from the legal language of two cases: Dusky v. United States
(1960) and Welter v. Settle (1961). Dusky states:
It is not enough for the districtjudge to find that the "defendant [is] oriented to time and
place and [has] some recollection of events,".., the "test must be whether he has
sufficient present ability to consult with his lawyer with a reasonable degree of rational
understanding--and whether he has a rational as well as factual understanding of the
proceedings against him." (p. 402, quoting United States Solicitor General Rankin)
The tests set out in Dusky are further elaborated in Weiter, which requires that the
defendant's "elementary mental processes [be] such that he apprehends (ie.,
seizes and grasps with what mind he has) that he is in a Court of Justice, charged
with a criminal offense," and that he be cognizant of the significant legal actors
and their roles in the proceedings (i.e., the judge, prosecutor, defense attorney,
jury, etc). Both of these cases set forth standards that require a defendant to be
oriented to the world around him or her (i.e., that he or she have the "mental
capacity to appreciate his presence in relation to time, place, and things"), and
have "memory sufficient to relate [the facts surrounding him at the time of the
offense at the time and place where the law violation is alleged to have been
committed] in his own personal manner" (Weiter, 1961, pp. 321-322).
These cases establish a two-pronged test of competency: The defendant must
meet the requirements of a cognitive prong, and an interpersonal/behavioral co-
operation prong. The cognitive prong is encompassed in legal language concern-
ing (a) orientation, (b) understanding or "apprehension," (c) memory, and (d) at
least a rudimentary synthesis of the charges, the court principals, potential pleas,
NEUROPSYCHOLOGY AND CRIMINAL LAW 323

and outcomes. These cognitive requirements are striking in their similarity to the
mental functions assessed in a standard neuropsychological evaluation. The men-
tal abilities required by the cognitive prong reflect the direct relevance of neuro-
psychological evidence. A wide range of brain disorders can impair a defendant's
abilities relevant to these standards, including mental retardation (Travin, Klein,
& Protter, 1985), various forms of dementia, amnesia and memory impairments, 1
and frontal lobe dysfunction.
The interpersonal/behavioral cooperation prong involves the defendant's
ability to communicate effectively with an attorney, and to participate effectively
in his or her own defense. The Dusky test begins by requiring that the defendant
have "sufficient present ability" to cooperate with counsel. Establishing the level
of functioning that constitutes sufficient present ability in a given case is ulti-
mately a judicial determination. However, neuropsychological testimony can and
should provide objective data to help establish whether a given defendant's
present abilities are legally sufficient. This entails assessment of the defendant's
ability to comprehend an attorney's instructions or advice, and to make reasoned
decisions based on that advice. It also involves assessing the ability to collaborate
effectively in developing and pursuing a defense, for example, the ability to attend
to the testimony of witnesses and inform the attorney of discrepancies or con-
cerns. Many forms of brain damage can interfere with these abilities. For exam-
ple, disorders of language known as aphasias can significantly interfere with a
defendant's ability either to comprehend spoken language (receptive aphasia) or
to communicate effectively through language (expressive aphasia). Similarly, dis-
orders of attention, concentration, and memory may impair a defendants ability to
attend to and follow events in the trial over several days.
Literature on the applied psychological evaluation of competency to stand
trial (e.g., Grisso, 1986; Melton, Petrila, Poythress, & Slobogin, 1987; Roesch &
Golding, 1987) has not addressed its neuropsychological assessment in any depth.
However, neuropsychological evidence regarding competency is relevant in at
least two primary areas: (a) determinations of the defendant's present ability to
proceed in court; and (b) after a determination of incompetency, in the assessment
of the defendant's potential for restoration of fitness to proceed pursuant to Jack-
son v. Indiana (1972). In many cases, determinations of present competency to
stand trial would benefit from neuropsychological assessment. This is particularly
true in cases where the reason for a defendant's apparent incompetency is un-
clear. For example, referral for forensic neuropsychological evaluation could be
indicated when mental status examination suggests memory impairment, atten-
tional deficits, mental retardation, some other organic basis for the defendant's
incompetency, or malingering.
However, the role for forensic neuropsychology is likely to become even

1 There is also a large literature concerning distinctions between memory disorders and amnesia.
Differential diagnosis of these conditions, and relationships between amnesia and competency to
stand trial, clearly fall within the forensic neuropsychologist's bailiwick. However, the clinical
contours of this controversial issue have been addressed at length elsewhere (cf. Hermann, 1986a,
1986b; Kopelman, 1987; Roesch & Golding, 1986; Rnbinsky & Brandt, 1986; Wilson v. U.S., 1968).
324 MARTELL

more important after a finding of incompetency. The Supreme Court's landmark

decision in Jackson v. Indiana (1972) created a largely unexplored territory for
forensic evaluations in competency determination. In Jackson, the Court held, in
part, that
a defendantcannotbe held more than the reasonableperiod of time necessaryto deter-
mine whether there is a substantial probability that he will attain competencyin the
foreseeablefuture. If it is determinedthat he willnot, the State musteitherinstitutecivil
proceedings applicable to indefinitecommitmentof those not charged with a crime, or
release the defendant.(p. 406)
This decision places a burden squarely on forensic clinicians to actively evaluate
an incompetent defendant's potential for restoration to competency. Jackson thus
provides what may become the greatest single opportunity for neuropsychology to
play a unique and critical informative role in competency proceedings.
Martell and Sanders (1991) present the first clinical data on this class of
defendants in the 20 years since the Jackson decision. They report on all cases
converted to civil status pursuant to Jackson from a maximum-security hospital in
New York City over a five year period. Of these, 70% had documented evidence
of neuropsychological brain abnormality. Specific disorders included AIDS-
dementia, Pick's disease, Alzheimer's disease, mental retardation, and alcoholic
dementia.
In such cases, the neuropsychologist can establish a defendant's current level
of functioning, relate it to available history and baseline data, and perform serial
testing to document any significant change in the neuropsychological status of the
defendant over time. It also may be important in cases where it is unclear why a
defendant is not responding to treatment. For example, many forensic psychiatric
patients with organic disorders are misdiagnosed with major psychotic disorders
(e.g., schizophrenia; Martell, 1992). In some cases, treatment with antipsychotic
medications may actually exacerbate the symptom presentation in these patients
(Hales & Yudofsky, 1987). Careful neuropsychological assessment would help to
clarify the diagnostic picture, as well as offering suggestions for alternative treat-
ments.

Criminal Responsibility, Diminished Capacities, and the Insanity Defense

The forensic neuropsychological issues in this area are less clear cut than
those of competency to stand trial, and the role for neuropsychology is arguably
more controversial. However, there may be an increasingly viable role for neu-
ropsychology here. Brain damage is coming to be viewed as a potential risk factor
for violent behavior in conjunction with other personal, environmental, and sit-
uational risk factors (Martell, 1992).
Recent advances in neuroscience, driven largely by the advent of new imag-
ing technologies for the study of brain structure and function, are raising impor-
tant new issues in the criminal law. Increasingly, data from these new technolo-
gies are being introduced as dramatic evidence of brain damage in insanity pro-
ceedings (e.g., U . S . v . Hinckley, 1982). However, as noted earlier, while
neuroimaging technologies can provide powerful evidence of the presence, type,
NEUROPSYCHOLOGYAND CRIMINAL LAW 325

location, size, and angle of brain lesions, they provide the trier of fact with little
information about the behavioral sequelae of a given lesion. It is precisely in this
area that the neuropsychologist is best prepared to provide evidence to inform the
decision-making process. It may prove useful to document the preservation of
abilities despite the presence of a known lesion, or alternatively to delineate the
extent and quality of disability associated with the lesion.
Historically, two precedents have emerged to regulate insanity determina-
tions in American jurisprudence: the McNaughtan standard, and the American
L a w Institute (ALI) standard (Model Penal Code, 1962). There is a significant
literature that addresses the psychological issues raised by these standards (e.g.,
Golding & Roesch, 1987; Melton et al., 1987; Monahan & Walker, 1990). The
McNaughtan standard states:
To establish a defense on the ground of insanity, it must be clearly proved that, at the
time of committing the act, the party accused was laboring under such a defect of reason,
from disease of the mind, as not to know the nature and quality of the act he was doing;
or ff he did know it, that he did not know what he was doing was wrong. (p. 718)

The language of the McNaughtan standard essentially establishes a largely cog-

nitive test for insanity, being concerned primarily with the extent to which the
defendant did or did not know what s/he was doing. In contrast, the ALI language
modifies the test for insanity:

A person is not responsible for criminal conduct if at the time of such conduct as a result
of mental disease or defect he lacks substantial capacity either to appreciate the crimi-
nality (wrongfulness) of his conduct or to conform his conduct to the requirements of
law.

By interjecting the term " a p p r e c i a t e , " the A L I test broadens the cognitive Mc-
Naughtan standard to encompass affective and emotional factors as well as cog-
nitive factors. F r o m a neuropsychological perspective, " a p p r e c i a t i o n " implies
higher-order cognitive abilities that might range from simple awareness or recog-
nition, to a fairly sophisticated ability to note distinctions or to be conscious of the
significance, desirability, or impact of his or her behavior. A number of brain
disorders, especially damage to the frontal cortex, can effectively impair the
ability to accurately perceive or reflect on one's own behavior (Hall & McNinch,
1988). F o r example, disorders known as agnosias result in a deficiency of self-
awareness or self-perception (Lezak, 1983) that may impair a defendant's ability
to appreciate the nature and/or consequences of his or her behavior.
Secondly, the A L l standard does not require a defendant's total lack of
appreciation o f the nature of his or her conduct, but rather that he or she "lacks
substantial c a p a c i t y . " Determining what is legally "substantial" ultimately falls
to the trier-of-fact. H o w e v e r , the neuropsychologist is in a good position to quan-
tify and characterize the degree of impairment exhibited by a defendant, and to aid
the fact-finder in determining whether such a level of impairment constitutes a
" s u b s t a n t i a l " lack o f capacity. F o r example, a neuropsychologist might present
data showing that the defendant falls three standard deviations below the mean on
tests of social judgment and goal-directed behavior. The judge or jury could then
326 MARTELL

use that evidence in determining whether that degree of impairment in those

aspects of behavior constitutes a substantial lack of capacity.
Finally, the ALl test adds a "volitional" clause concerning the defendant's
ability (or inability) to control his actions. The volitional clause, however, came
under considerable scrutiny in the post-Hinckley era, and while it remains in force
in some jurisdictions it was eliminated from the federal standards in 1984 (Mayer
& Steadman, 1987).
Constriction of the volitional prong of the ALl test in the post-Hinckley era
reflects potentially erroneous assumptions about the impact of mental disease or
defect on "volitional" human behavior (Hall & McNinch, 1988; Perlin, 1990;
Tancredi & Volkow, 1988). This is consistent with the APA's position on the
insanity defense (American Psychological Association, 1984), which opposed the
elimination of the volitional prong until more research data become available to
assess its basis in scientific reality. A growing body of research literature has
developed linking violence and brain dysfunction (e.g., Langevin, et al., 1987;
Silver & Yudofsky, 1987; Volkow & Tancredi, 1987). In addition, a neuropsy-
chology of intent is evolving (Brown, 1987; Goldberg, 1987), implicating frontal
lobe defects in the impaired control, planning, and organization of behavior (see
Hall & McNinch, 1988). As noted above, frontal lobe syndromes have been
clearly associated with violent behavior (Heinrichs, 1989; Kling 1976; Pontius,
1984; Volkow & Tancredi; 1987), and may go directly to the issue of volitional
impairment (Gorenstein, 1990; Kendel & Freed, 1989). Similarly, there is a grow-
ing literature relating temporal lobe functioning and violence, including contro-
versial studies of temporal lobe epilepsy (Devinsky & Bear, 1984; Furgeson,
Rayport, & Corrie, 1986; Monroe, 1986; Stone, 1984), episodic dyscontrol (Rick~
ler, 1982), and temporal lobe lesions secondary to head injury (Wood, 1984).
Diminished Capacities. A related area of criminal responsibility determina-
tion with significant potential for forensic neuropsychological input is the evalu-
ation of diminished capacities. Conceptually distinct from insanity determination,
a diminished capacities defense attempts to reduce the severity of the charge by
challenging the mental element of the prosecution's prima facie case (cf. McCord,
1987; Monahan & Walker, 1990). For example, distinctions between murder,
manslaughter, and nonnegligent homicide often hinge on whether the prosecution
can show that the crime was committed intentionally, knowingly, recklessly, or
negligently (Morse, 1984). Unlike the insanity defense, which admits the criminal
act but asserts that the defendant had no criminal intent, the diminished capacities
defense attempts to show that the defendant was able to form less than the crim-
inal intent required by the charge, and hence should only be convicted of a lesser
offense.
McCord (1987) notes that although diminished capacities is distinct from the
insanity defense, the psychological evidence presented is often quite similar.
Here, forensic neuropsychological evidence could be used to establish the cog-
nitive abilities of the defendant relevant to the legal definitions of the state of mind
required to constitute the offense. For example, a defendant with Alzheimer's
disease may lack the ability to organize and plan his or her behavior adequately to
NEUROPSYCHOLOGYAND CRIMINALLAW 327

form the legal intent required to commit arson, and hence may only be found
guilty of a lesser charge such as reckless endangerment.

Other Competencies Arising in the Criminal Process

Neuropsychological evidence also may become increasingly important in a
range of other criminal competency issues, including waiver of Miranda rights,
competency to confess, competency to make a plea, competency to be sentenced,
predictions of dangerousness pursuant to the death penalty, and competency to be
executed (cf. Heilbrun & McClaren, 1988; Melton et al., 1987; Perlin, 1987; Small
& Otto, 1991). Recent judicial decisions in several of these areas raise important
issues of potential neuropsychological relevance.
For example, in the U.S. Supreme Court's controversial decision in Penry v.
Lynaugh (1989), mental retardation alone was found to be insufficient to declare
a defendant incompetent to be executed. The court held that the jury must weigh
the defendant's mental status, and the extent to which the mental retardation is so
profound or severe as to render the defendant incapable of understanding the
punishment and why he or she is to receive it. Here, neuropsychological evidence
regarding not only the degree of retardation, but its impact on the defendants
comprehension, understanding, and abstract concept formation could be intro-
duced. Similar death penalty cases involving the mentally ill (e.g., Ford v. Wain-
wright, 1986) also warrant a consideration of neuropsychological evaluation, es-
pecially in light of the prevalence of brain damage attributed to death row inmates
by Lewis and her colleagues (Lewis et al., 1986, 1988).
Across many of these areas, neuropsychological evidence may have greatest
relevance as it involves the potential extension of the legal theory set out in
Jackson v. Indiana regarding whether the defendant will ever be restored to
competency. In death penalty cases, for example, a progressive brain disease may
prevent a condemned inmate from ever regaining the mental capacity required to
meet the test of competency to be executed. Radelet and Barnard (1988) advocate
commutation of the death sentence in cases where the defendant is found incom-
petent. As ethically appealing as this would be for mental health professionals (cf.
Bonnie 1990; Brodsky, 1990), it is unlikely to be adopted as a matter of legal
policy. However, assessment of potential for restoration to competence for exe-
cution would be consistent with the precedent established in Jackson, and seems
a more probable judicial approach.

Admissibility of Expert Neuropsychological Testimony

The basic equivalence of clinical psychologists and medical doctors to pro-
vide testimony regarding a defendant's mental state in criminal cases was first
acknowledged in Jenkins v. United States (1962), which eschewed the medical/
nonmedical distinction in favor of evaluating the probative value of the testimony
to aid the trier-of-fact. However, challenges to the admissibility of neuropsycho-
logical evidence have arisen in several recent civil cases (cf. Satz, 1988; Schwartz,
1987). The first two cases moved to limit or exclude neuropsychological evidence
328 MARTELL

on the basis that psychologists are not medical doctors, and hence were unqual-
ified to render on opinion regarding the presence of brain damage (Executive Car
& Truck Leasing v. DeSerio, 1985; GIW Southern Valve Co. v. Smith, 1985). In
both cases, the Florida Court of Appeals reversed the lower courts' admission of
neuropsychological testimony, effectively excluding neuropsychological evi-
dence.
However, a third civil case (Home v. Goodson Logging Co., 1985) served to
establish the admissibility of neuropsychological testimony. Partly in response to
the Florida decisions, the American Psychological Association together with the
North Carolina Psychological Association submitted an amicus brief in support of
neuropsychological evidence in H o m e v. Goodson (Bersoff & Majestic, 1986).
Apparently the brief was influential in this case. The North Carolina Court of
Appeals upheld the admissibility of neuropsychological evidence, with the cred-
ibility of the expert left to the discretion trial court judge.
While these three cases established precedents for the admissibility of neuro-
psychological evidence in civil proceedings, such evidence has also become an
issue in criminal proceedings. In at least one prominent criminal case (People v.
Wright, 1982), the Supreme Court of Colorado determined en banc that a neu-
ropsychologist's testimony regarding test evidence of minimal brain dysfunction
was properly admitted into evidence in support of a defendant's successful insan-
ity defense.
Rules governing the admissibility of expert psychological evidence vary by
jurisdiction and often by the judge hearing a given case, who must determine
admissibility in a given case (Lempert & Saltzberg, 1982). The Federal Rules of
Evidence (1975; particularly FRE 401-403 and 702-704) establish a relevancy ap-
proach, admitting any evidence that the judge determines to be relevant so long as
(a) it will assist the trier of fact, and (b) its probative value does not outweigh its
prejudicial impact (Monahan & Walker, 1990). Under the FRE, a case could
certainly be made for the relevancy of neuropsychological evidence to address
criminal-legal issues and aid the trier of fact. Greater care is required, however, to
assure that its probative value outweighs its prejudicial impact.
Introducing evidence that the defendant is "brain damaged" can have a
powerful impact on judges and jury members, and the clinician must be careful not
to overstate what the data really reflect about the defendant's level of functioning
(Matarazzo, 1990; Shapiro, 1988). Simultaneously, as Ziskin and Faust (1988)
suggest, there are real limitations to the current state of knowledge in neuropsy-
chology and the neurobehavioral sciences in general, and their criminal/forensic
applications in particular. Ethically, the forensic neuropsychologist has a duty
both to consider and to address the ways in which a given defendant is adequately
represented by the tests selected and the norms applied. The availability of ade-
quate norms has been a problem in clinical neuropsychology, although recent
research has improved the situation considerably (cf. Bernard, 1989; Heaton et
al., 1991; Spreen & Strauss, 1991). To ensure that neuropsychological testimony
is more probative than prejudicial, it is incumbent upon the expert to know and to
be explicit about the limitations of the available norms as they apply in a given
case (cf. Golding, 1990; Matarazzo, 1990).
NEUROPSYCHOLOGY AND CRIMINAL LAW 329

Other rules specific to the admissibility of scientific evidence arise from Frye
v. U.S. (1923). Frye established a "general acceptance" test, requiring that the
scientific evidence introduced must be established and recognized in the partic-
ular field of expertise in order to be admitted into evidence. National surveys of
the mainstream methods of neuropsychological assessment (cf. Guilmette, Faust,
Hart, & Arkes, 1990; Seretny, Dean, Gray, & Hartledge, 1986) suggest that the
Halstead-Reitan Battery, the Luria-Nebraska Battery, and Kaplan's (1990) "pro-
cess/qualitative" approach are generally accepted methods, and hence clearly
satisfy the Frye test.
Finally, an alternative to the Frye test that has often been applied to novel
psychological evidence are the criteria established in Dyas v. United States
(1977). The Dyas criteria set forth a three-pronged test of "expertness," requiring
that:

1. the substance of the testimony be " s o distinctively related to some sci-

ence, profession, business or occupation as to be beyond the ken of the
average layman,"
2. that "the witness must have sufficient skill, knowledge, or experience in
that field or calling as to make it appear that his opinion or inference will
probably aid the trier in his search for truth," and
3. that expert testimony is inadmissible if "the state of the pertinent art or
scientific knowledge does not permit a reasonable opinion to be asserted
even by an expert."

The third prong of the Dyas test was further clarified in a subsequent case (Ibn-
Tamas v. U.S., 1979) in which the court established that it "begins and ends with
a determination of a particular scientific methodology, and not an acceptance,
beyond that, of a particular study's results based on that methodology" (as quoted
by Monahan & Walker, 1990, p. 343).
An argument can be made for neuropsychological testimony on each of
these three points. First, neuropsychology is clearly an area of specialized
knowledge that falls beyond the ken of the layman. The determination of the
neuropsychologist witness's skill is a judicial prerogative [as affirmed in Horne
v. Goodson (1985) and People v. Wright (1982)], and generally can be estab-
lished on voir dire. Guilmette and Giuliano (1991) discuss the research findings
related to witness skill, examining training, experience, and judgment accur-
acy. They note that while proper training is important to accurate judgments,
greater experience does not necessarily result in greater diagnostic accuracy.
In fact, properly trained neuropsychologists with less experience are gener-
ally as accurate as or more accurate than those with more experience. Finally, the
state-of-the-art in neuropsychology--even bounded by current limitations in
the research base--does permit a reasonable opinion on many issues of direct
relevance in criminal proceedings. The substance of this prong (as interpreted
in lbn-Tamas) is generally consistent with the "general acceptance" test estab-
lished in Frye, and mainstream neuropsychological tests clearly meet this stan-
dard.
330 MARTELL

DISCUSSION

This article has explored some of the potential forensic applications of clinical
neuropsychology to issues in the criminal law. The documented presence of brain
damage---in and of itself--is not an adequate basis for legal decision making.
Rather, what is required is a clear and systematic exposition of the nature, extent,
and course of the defendant's brain dysfunction, and a careful explanation of the
consequences this has in terms of the behavior of the defendant relative to the
psycholegal issue at hand. Clinical neuropsychology holds significant potential to
inform legal decision making in the criminal law, although much of that potential
is currently uptapped.
Although the current state of the art in clinical neuropsychology arguably
meets the criteria for admissibility, more research is needed to advance the sci-
entific foundation for opinions regarding the neuropsychological parameters of
criminal/forensic issues (Grisso, 1987; Matarazzo, 1987). Neuropsychology is an
area of rapid growth in which new and exciting data are being produced each year.
Studies are appearing that address areas criticized by Ziskin and Faust (1988),
including norms over the life span (Faibish, Auerbach, & Thornby, 1986; Heaton
et al., 1991; Yeudall, Reddon, Gill, & Stefanyk, 1987), racial, ethnic, and cultural
differences in test performance (Bernard, 1989), and the effects of age, education,
IQ, gender, and alcohol abuse on neuropsychological test performance (Heaton et
al., 1991; Leckliter & Matarazzo, 1989; Matarazzo, 1990). In conjunction with
newer neuroradiological techniques (e.g., PET, SPECT), researchers are now
able to assess the brain's regional response to the "challenge" of specific neuro-
psychological tests (cf. Chase et al., 1984; Parks et al., 1989; Posner, Peterson,
Fox, & Raichle, 1988).
However, additional ecologically valid research is still needed to address
these and other issues, including (a) behavioral sequelae of localized brain lesions,
(b) violence and brain function, (c) base rates in forensic populations, and (d)
studies relevant to legal criteria such as predictions of restorability to fitness. The
future value of criminal/forensic neuropsychology can be expected to increase as
a direct function of advances in these areas of the established knowledge base.
The challenge for the present is to bring forensic neuropsychological evidence into
the criminal courtroom and establish the value of its contributions to legal deci-
sion making in the criminal law.

REFERENCES

American Psychological Association (1984). Policy statement on the insanity defense. Washington,
DC: American Psychological Association.
Anchor, K. N., Rogers, J. P., Solomon, G. S., Barth, J. T., & Peacock, C. (1983). Alternatives to
medical testimony in determining vocational and industrial disability. American Journal of Trial
Advocacy, 6(3), 443--480.
Anchor, K. N., Rogers, J. P., Solomon, G. S., Barth, J. T., Peacock, C., & Martell, D. A. (1985).
NEUROPSYCHOLOGY AND CRIMINAL LAW 331

Fundamentals of disability determination and rehabilitation: A higher ground for the applied
neurobehavioral sciences. American Journal of Trial Advocacy, 8(3), 337-375.
Barth, J. T., Gideon, D. A., Sciara, A. D., Hulsey, P. H., & Anchor, K. N. (1986). Forensic aspects
of mild head injury. Journal of Head Trauma Rehabilitation, 1, 63-70.
Berman, A., & Siegal, A. M. (1976). Adaptive learning skills in juvenile delinquents: A neuropsycho-
logical analysis. Journal of Learning Disabilities, 9, 583-590.
Bernard, L. C. (1989). Halstead-Reitan Neuropsychological Test performance of Black, Hispanic,
and White young adult males from poor academic backgrounds. Archives of Clinical Neuropsy-
chology, 4(3), 267-274.
Bersoff, D. N., & Majestic, A. L. (1986, Aug.). Motion for leave to file brief of Amici Curiae and brief
of American Psychological Association and North Carolina Psychological Association as Amici
Curiae in support of appellant. North Carolina Court of Appeals Docket #1-1606, Home v.
Goodson Logging and Self-Insured.
Bigler, E. D. (1986). Forensic issues in neuropsychology. In D. Wedding, A. M. Horton, Jr., & J.
Webster (Eds.), The neuropsychology handbook: Behavioral and clinical perspectives. New
York: Springer.
Bigler, E. D. (1990). Neuropsychology and malingering: Comment on Faust, Hart and Guilmette
(1988). Journal of Consulting and Clinical Psychology, 58(2), 244-247.
Binder, L. M., & Pankratz, L. (1987). Neuropsychological evidence of a factitious memory complaint.
Journal of Clinical and Experimental Neuropsychology, 9, 167-171.
Boll, T. J. (1978). Diagnosing brain impairment. In B. Wolman (Ed.), Clinical diagnosis of mental
disorders. New York: Plenum.
Boll, T. J. (1981). The Halstead-Reitan Neuropsychological battery. In S. B. Filskov & T. J. Boll
(Eds.), Handbook of clinical neuropsychology, Vol. 1. New York: Wiley.
Boll, T. J. (1985). Developing issues in clinical neuropsychology. Journal of Clinical and Experimental
Neuropsychology, 7, 473-485.
Bonnie, R. J. (1990). Dilemmas in administering the death penalty: Conscientious abstention, profes-
sional ethics, and the needs of the legal system. Law and Human Behavior, 14(1), 91-97.
Brodsky, S. L. (1989). Advocacy in the guise of scientific advocacy: An examination of Faust and
Ziskin. Computers in Human Behavior, 5, 261-264.
Brodsky, S. (1990). Professional ethics and professional morality in the assessment of competence for
execution: A response to Bonnie. Law and Human Behavior, 14(1), 91-97.
Brown, J. W. (1987). The microstructure of action. In E. Perecman (Ed.), The frontal lobes revisited.
New York: IRBN Press.
Bryant, E. T., Scott, M. L., Golden, C. J., & Toil, C. D. (1984). Neuropsychological deficits, learn-
ing disability, and violent behavior. Journal of Consulting and Clinical Psychology, 52(2), 323-
324.
Butler, R. W., Anderson, L., Furst, C. J., Namerow, N. S., & Satz, P. (1989). Behavioral assessment
in neuropsychological rehabilitation: A method for measuring vocational-related skills. The Clin-
ical Neuropsychologist, 3, 235-243.
Chase, T. N., Fedio, P., Foster, N. L., Brooks, R., Di Chiro, G., & Mansi, L. (1984). Wechsler Adult
Intelligence Scale performance: Cortical localization by fluoride-oxyglucose F 18-positron emis-
sion tomography. Archives of Neurology, 41, 1244-1247.
Devinsky, O., & Bear, D. (1984). Varieties of aggressive behavior in temporal lobe epilepsy. American
Journal of Psychiatry, 141, 651-656.
Dicker, T. E. (1973). WAIS characteristics of indicted male murderers. Psychological Reports, 32,
1066.
Duncan, D., & Snow, W. G. (1987). Base rates in neuropsychology. Professional Psychology: Re-
search and Practice, 18(4), 368-370.
Dusky v. United States, 362 U.S. 402, 80 S.Ct. 788, 4 L.Ed. 2d, 824 (1960).
Dyas v. United States, 376 A.2d 827 (1977).
Executive Car & Truck Leasing v. DeSerio, 468 So. 2d 1027 (Fla App 4 Dist. 1985).
Falbish, G. M., Auerbach, V. S., & Thornby, J. I. (1986). Modifications of the Halstead-Reitan in
geriatrics. Clinical Gerontologist, 6(1), 3-14.
332 MARTELL

Faust, D., Hart, K. J., Guilmette, T. J., & Arkes, H. R. (1988). Neuropsychologists' capacity to
detect adolescent malingerers. Professional Psychology Research and Practice, 19(5), 508-515.
Fedora, O., & Fedora, S. (1983). Some neuropsychological and psychophysiological aspects of psy-
chopathic and nonpsychopathic criminals. In P. Flor-Henry and J. H. Gruzelier (eds.), Laterality
and psychopathology. Amsterdam: Elsevier.
Filskov, S., & Goldstein, S. (1974). Diagnostic validity of the Halstead-Reitan neuropsychology
battery. Journal of Clinical and Consulting Psychology, 42, 383-388.
Ford v. Wainwright, 106 S.Ct. 2595 (1986).
Franzen, M. (1989). Reliability and validity in neuropsychological assessment. New York: Plenum
Press.
Frye v. United States, 293 Fed 1013 (D.C. Cir. 1923).
Furgeson, S. M., Rayport, M., & Corrie, W. S. (1986). Brain correlates of aggressive behavior in
temporal lobe epilepsy. In B. Doane & K. Livingston (Eds.), The limbic system: Functional
organization and clinical disorders. New York: Raven Press.
Gilandas, A. J., & Touyz, S. W. (1982). The neuropsychologist as expert witness. Australian Psy-
chologist, 17(3), 255-264.
Gilandas, A. J., & Touyz, S. W. (1983). Forensic neuropsychology: a selective introduction. Journal
of Forensic Sciences, 28(3), 713-723.
GIW Southern Valve Co. v. Smith, 471 South 2nd 81 (FIA App 2 Dist., 1985).
Goebel, R. A. (1983). Detection of faking on the Halstead-Reitan neuropsychological test battery.
Journal of Clinical Psychology, 39(5), 731-742.
Goldberg, G. (1987). From intent to action: Evolution and function of the premotor systems of the
frontal lobe. In E. Perecman (Ed.), The frontal lobes revisited. New York: IRBN Press.
Golden, C. J. (1981). A standardized version of Luria's neuropsychological tests: A quantitative and
qualitative approach to neuropsychological evaluation. In S. B. Filskov & T. J. Boll (Eds.),
Handbook of clinical neuropsychology, vol. 1. New York: Wiley.
Golden, C. J. (1986). Examples of test research information necessary for forensic testimony. In C. J.
Golden, & M. A. Strider (Eds.), Forensic neuropsychology (pp. 139-182). New York: Plenum.
Golden, C. J., & Strider, M. A. (1986). Forensic neuropsychology. New York: Plenum.
Golding. S. L. (1990). Mental health professional and the courts: The ethics of expertise. International
Journal of Law and Psychiatry, 13, 281-307.
Golding, S. L., Roesch, R. (1987). The assessment of criminal responsibility: A historical approach to
a current controversy. In I. B. Weiner and A. K. Hess (Eds.), Handbook of forensic psychology.
New York: Wiley.
Gorenstein, E. E. (1990). Neuropsychology of juvenile delinquency. Forensic Reports, 3(1), 15--48.
Gorenstein, E. E., & Newman, J. P. (1980). Disinhibitory psychopathology: A new perspective and a
model for research. Psychological Review, 87(3), 301-315.
Grisso, T. (1986). Evaluating competencies: Forensic assessments and instruments. New York: Ple-
num.
Grisso, T. (1987). The economic and scientific future of forensic psychological assessment. American
Psychologist, 42(9), 831-839.
Guilmette, T. J., Faust, D., Hart, K., & Arkes, H. R. (1990). A national survey of psychologists who
offer neuropsychological services. Archives of Clinical Neuropsychology, 5, 373-392.
Guilmette, T. J., & Giuliano, A. J. (1991). Taking the stand: Issues and strategies in forensic neuro-
psychology. The Clinical Neuropsychologist, 5(3), 197-219.
Hafner, H., and B6ker, W. (1982). Crimes of violence by mentally abnormal offenders: A psychiatric
and epidemiological study in the Federal German Republic. Cambridge, Cambridge University
Press.
Hales, R. E., & Yudofsky, S. C. (1987). Textbook of neuropsychiatry. Washington, DC: American
Psychiatric Association Press.
Hall, H. V., & McNinch, D. (1988). Linking crime-specific behavior to neuropsychological impair-
ment. The International Journal of Clinical Neuropsychology, 10(3), 113-122.
Hare, R. D., & McPherson, L. M. (1984). Violent and aggressive behavior by criminal psychopaths.
International Journal of Law and Psychiatry, 7, 35-50.
NEUROPSYCHOLOGY AND CRIMINAL LAW 333

Heaton, R., Grant, I., & Matthews, C. (1991). Comprehensive norms for an expanded Halstead-
Reitan Battery: Demographic corrections, research findings, and clinical applications. Odessa,
FL: Psychological Assessment Resources.
Heaton, R. K., & Pendleton, M. G. (1981). Use of neuropsychological tests to predict adult patients'
everyday functioning. Journal of Consulting and Clinical Psychology, 49(6), 807-821.
Heaton, R. K., Smith, H. H., Lehman, R. A. W., & Vogt, A. T. (1978). Prospects for faking believ-
able deficits on neuropsychological testing. Journal of Clinical and Consulting Psychology, 46(5),
892-900.
Heilbrun, K. S., & McClaren, H. A. (1988). Assessment of competency for execution? A guide for
mental health professionals. Bulletin of the American Academy of Psychiatry and the Law, 16(3),
205-215.
Heinrichs, R. W. (1989). Frontal cerebral lesions and violent incidents in chronic neuropsychiatric
patients. Biological Psychiatry, 25, 174-178.
Heinrichs, R. W. (1990). Current and emergent applications of neuropsychological assessment: Prob-
lems of validity and utility. Professional Psychology Research and Practice, 21(3), 171-176.
Hermann, D. H. J. (1986a). Criminal defenses and pleas in mitigation based on amnesia. Behavioral
Sciences and the Law, 4, 5-26.
Hermann, D. H. J. (1986b). Amnesia and criminal law. Idaho Law Review, 22, 257-289.
Ibn-Tamas v. United States, 407 A.2d 626 (D.C. Court of Appeals 1979).
Incagnoli, T. (1985). Clinical neuropsychologists. Trial, 21, 60--63.
Jackson v. Indiana, 406 U.S. 715 (1972).
Jarvis, P. E., & Barth, J. T. (1984). Halstead-Reitan test battery:An interpretive guide. Odessa, FL:
Psychological Assessment Resources.
Jenkins v. United States, 307 F 2nd 637 (D.C. Cir. 1962).
Jutai, J. W., & Hare, R. D. (1983). Psychopathy and selective attention during performance of a
complex perceptual-motor task. Psychophysiology, 20(2), 146-151.
Kane, R. L., Parsons, O. A., & Goldstein, G. (1985). Statistical relationships and discriminative
accuracy of the Halstead-Reitan, Luria-Nebraska, and Wechsler IQ scores in the identification of
brain damage. Journal of Clinical and Experimental Neuropsychology, 7(3), 211-223.
Kaplan, E. (1990). The process approach to neuropsychological assessment of psychiatric patients.
Journal of Neuropsychiatry and Clinical Neurosciences, 2(1), 72-87.
Kendel, E., & Freed, D. (1989). Frontal lobe dysfunction and antisocial behavior: A review. Journal
of Clinical Psychology, 45(3), 4(14--413.
Kling, A. (1976). Frontal and temporal lobe lesions and aggressive behavior. In W. Smith & A. Kling
(Eds.), Issues in brain~behavior control. New York: Spectrum.
Konecni, V. J., & Ebbeson, E. B. (1979). External validity of research in legal psychology. Law and
Human Behavior, 3, 3%70.
Kopelman, M. D. (1987). Crime and amnesia: A review. Behavioral Sciences and the Law, 5(3),
323-342.
Kunce, J. T., Ryan, J. J., & Eckelman, C. C. (1976). Violent behavior and differential WAIS char-
acteristics. Journal of Consuhing and Clinical Psychology, 44(1), 42-45.
Kurlychek, R. T. (1984). The contributions of forensic neuropsychology. American Journal of Foren-
sic Psychology, 2(4), 147-150.
Langevin, R., Ben-Aron, M., Wortzman, G., Dickey, R., & Handy, L. (1987). Brain damage, diag-
nosis, and substance abuse among violent offenders. Behavioral Sciences and the Law, 5(1),
77-94.
Leckliter, I. N., & Matarazzo, J. D. (1989). The influence of age, education, IQ, gender, and alcohol
abuse on Halstead-Reitan Neuropsycliological Test Battery performance. Journal of Clinical
Psychology, 45, 484-511.
Lempert, R. O., & Saltzberg, S. A. (1982). A modern approach to evidence: Text, problems, tran-
scripts, and cases. St. Paul: MN: West.
Lewis, D. O., Pincus, J. H., Bard, B., Richardson, E., Prichep, L. S., Feldman, M., & Yeager, C.
(1988). Neuropsychiatric, psyclioeducational, and family characteristics of 14 juveniles con-
demned to death in the United States. American Journal of Psychiatry, 145, 584-589.
Lewis, D. O., Pincus, J. H., Feldman, M., Jackson, L., & Bard, B. (1986). Psychiatric, neurological,
334 MARTELL

and psychoeducational characteristics of 15 death row inmates in the U.S. American Journal of
Psychiatry, 143, 838--845.
Lezak, M. D. (1983). Neuropsychological assessment (2nd ed.). New York: Oxford University Press.
Mack, J. L. (1980). The use of neuropsychological testimony in civil court proceedings. In G. Cooke
(Ed.), The role of the forensic psychologist. Springfield, IL: Thomas.
Martell, D. A. (1992). Estimating the prevalence of organic brain dysfunction in maximum-security
forensic patients. Journal of Forensic Sciences, JFSCA, 37(3), 878-893.
Martell, D. A., & Sanders, S. (1991). Mentally disordered offenders who cannot be restored to com-
petency: A study of 20 cases converted to civil status pursuant to Jackson v. Indiana. Unpublished
manuscript, NYU/Bellevue Medical Center and Kirby Forensic Psychiatric Center, New York,
NY.
Matarazzo, J. D. (1972). Wechsler's measurement and appraisal of adult intelligence (5th ed). Balti-
more, MD: Williams and Wilkins.
Matarazzo, J. D. (1987). Validity of psychological assessment: From the clinic to the courtroom.
Clinical Neuropsychologist, 1(4), 307-314.
Matarazzo, J. D. (1990). Psychological assessment versus psychological testing: Validation from the
Binet to the school, clinic, and courtroom. American Psychologist, 45(9), 999-1017.
Mayer, S., & Steadman, H. (1987). Insanity defense reform in the United States--Post-Hinckley.
Mental and Physical Disability Law Reporter, 1l, 54-60.
McCord, D. (1987). Syndromes, profiles and other mental exotica: A new approach to the admis-
sibility of nontraditional psychological evidence in criminal cases. Oregon Law Review, 66, 19--
108.
McMahon, E. A. (1983). Forensic issues in clinical neuropsychology. In C. J. Golden & P. J. Vincente
(Eds.), Foundations of clinical neuropsychology. New York: Plenum Press.
McMahon, E. A., & Satz, P. (1981). Clinical neuropsychology: Some forensic applications. In S. B.
Filskov & T. J. Boll (Eds.), Handbook of clinical neuropsychology. New York: Wiley.
Melton, G. B., Petrila, J., Poythress, N. G., & Slobogin, C. (1987). Psychological evaluations for the
courts: A handbook for mental health professionals and lawyers. New York: Guilford.
Mench, A. J. (1984, August). Patterns of feigning brain damage on the Luria Nebraska Neuropsycho-
logical Battery. Paper presented at the 92nd annual meeting of the American Psychological asso-
ciation, Toronto, Canada.
Model Penal Code (1962). Section 4.01: American Law Institute formulation of the insanity defense.
Monahan, J., & Walker, L. (1990). Social science in law: Cases and materials (2nd ed.). Mineola, NY:
The Foundation Press.
Monroe, R. R. (1981). Brain dysfunction in prisoners. In J. R. Hays, T. K. Roberts, & K. S. Soloway
(Eds.), Violence and the violent individual. New York: SP Medical and Scientific Books.
Monroe, R. R. (1986). Episodic behavioral disorders and limbic ictus. In B. Doane & K. Livingston
(Eds.), The limbic system: Functional organization and clinical disorders. New York: Raven
Press.
Morse, S. (1984). Undiminished confusion in diminished capacity. Journal of Criminal Law and
Criminology, 75(1), 26-34.
Nachshon, I., & Denno, D. (1987). Violent behavior and cerebral hemisphere function. Chapter 11 in
S.A. Mednick, T. E. Moffitt, and S. A. Stack (Eds.), The causes of crime: New biological
approaches. (pp. 185-217). New York: Cambridge University Press.
Neighbors, H. W. (1987). The prevalence of mental disorder in Michigan prisons. Diagnostic Inter-
view Schedule (DIS) Newsletter, 4(2), 8--11.
Odejide, A. O. (1981). Some clinical aspects of criminology: A study of criminal psychiatric patients
at the Lantoro Psychiatric Institution. Acta Psychiatrica Scandinavia, 63(3), 208-224.
Pankratz, L. (1988). Malingering on intellectual and neuropsychological measures. In R. Rogers (Ed.),
Clinical assessment of malingering and deception. (pp. 169-194). New York: Guilford.
Parks, R. W., Crockett, D. J., Tuokko, H., Beattie, B. L., Ashford, J. W., Coburn, K. L., Zec,
R. F., Becker, R. E., McGeer, P. L., & McGeer, E. G. (1989). Neuropsychological "systems
efficiency" and positron emissions tomography. Journal of Neuropsychiatry, 1(3), 269-282.
Penry V. Lynaugh, 109 S.Ct. 2394 (1989).
People v. Wright, 648 P.2d 665 (1982).
NEUROPSYCHOLOGY AND CRIMINAL LAW 335

Perlin, M. L. (1987). The Supreme Court and the mentally disabled criminal defendant: Recent de-
velopments. Bulletin of the American Academy of Psychiatry and the Law, 15(4), 391--409.
Perfin, M. L. (1990). Unpacking the myths: The symbolism mythology of insanity defense jurispru-
dence. Case Western Reserve Law Review, 40, 599-731.
Pierce, D. M. (1985). Legal applications of neuropsychology. Western State University Law Review,
13, 161-170.
Pontius, A. A. (1984). Specific stimulus-evoked violent action in psychotic trigger reaction: A seizure-
like imbalance between frontal lobe and limbic systems? Perceptual and Motor Skills, 59, 299-333.
Pontius, A. A., & Yudowitz, B. S. (1980). Frontal lobe dysfunction in some criminal actions shown in
the narratives test. Journal of Nervous and Mental Disease, 168(2), 111-117.
Posner, M. I., Peterson, S. E., Fox, P. T., & Ralchle, M. E. (1988). Localization of cognitive oper-
ations in the human brain. Science, 240, 1627-1631.
Radelet, M. L., & Barnard, G. W. (1988). Treating those found incompetent for execution: Ethical
chaos with only one solution. Bulletin of the American Academy of Psychiatry and the Law, 16(4),
297-307.
Raz, S., & Raz, N. (1990). Structural brain abnormalities in the major psychoses: A quantitative
review of the evidence from computerized imaging. Psychological Bulletin, 108(1), 93-108.
Reitan, R. M., Wolfson, D. (1985). The Halstead-Reitan neuropsychological battery: Theory and
clinical interpretation. Tucson, AZ: Neuropsychology Press.
Ridder, K. C. (1982). Episodic dyscontrol. In D. F. Benson & D. Blumer (Eds.), Psychiatric aspects
ofneurologic disease (Vol. 2). New York: Grune & Stratton.
Roesch, R., & Golding, S. (1986). Amnesia and competency to stand trial: A review of legal and
clinical issues. Behavioral Sciences and the Law, 4(Winter), 87-97.
Roesch, R., & Golding, S. (1987). Defining and assessing competency to stand trial. In I. B. Weiner
and A. K. Hess (Eds.), Handbook of forensic psychology (pp. 378-394). New York: Wiley.
Rogers, R., & Ewing, C. P. (1989). Ultimate opinion proscriptions: A cosmetic fix and a plea for
empiricism. Law and Human Behavior, 13, 357-374.
Rubinsky, E. W., & Brandt, J. (1986). Amnesia and criminal law: A clinical overview. Behavioral
Sc&nces and the Law, 4(1), 27-46.
Satz, P. (1988). Neuropsychological testimony: Some emerging concerns. Clinical Neuropsychologist,
2(1), 8%100.
Schuster, R. (1989). Clinical neuropsychology: Application in criminal, civil, and family court matters.
In R. Rosner & R. Harmon (Eds.), Criminal court consultation (pp. 259-272). New York: Plenum.
Schwartz, M. L. (1987). Limitations on neuropsychological testimony by the Horida appellate deci-
sions: Action, reaction, and counteraction. Clinical Neuropsychologist, 1(1), 51-60.
Seretny, M. L., Dean, R. S., Gray, J. W., & Hartledge, L. C. (1986). The practice of clinical neuro-
psychology in the United States. Archives of Clinical Neuropsychology, 1, 5-12.
Shapiro, D. L. (1988). Ethical constraints in forensic settings: Understanding the limits of our exper-
tise. Psychotherapy in Private Practice, 6(1), 71-86.
Silver, J. M., & Yudofsky, S. C. (1987). Aggressive behavior in patients with neuropsychiatric dis-
orders. Psychiatric Annals, 17(6), 367-370.
Slobogin, C. (1989). The "ultimate issue" issue. Behavioral Science and the Law, 7(2), 259-266.
Small, M. A., & Otto, R. K. (1991). Evaluations of competency to be executed: Legal contours and
implications for assessment. Criminal Justice and Behavior, 18(2), 146--158.
Spellacy, F. (1977). Neuropsychological differences between violent and nonviolent adolescents.
Journal of Clinical Psychology, 33, 966-969.
Spellacy, F. (1978). Neuropsychological discrimination between violent and nonviolent men. Journal
of Clinical Psychology, 34(1), 49-52.
Spitzer, R. L., Williams, J. B. W., First, M., & Kendler, K. (1990). A proposal for DSM-IV: Solving
the "organic/nonorganic" problem. Journal of Neuropsychiatry and Clinical Neurosciences, 1(2),
126-127.
Spreen, D., & Strauss, E. (1991). A compendium of neuropsychological tests: Administration, norms,
and commentary. New York: Oxford Press.
Stone, A. (]984). Violence and temporal lobe epilepsy. American Journal of Psychiatry, 141(t2), 1641.
336 MARTELL

Tancredi, L. R., & Volkow, N. (1988). Neural substrates of violent behavior: Implications for law and
public policy. International Journal of Law and Psychiatry, 11, 13--49.
Travin, S., Klein, N., & Protter, B. (1985). Mental retardation, organic brain dysfunction, and the
forensic clinician: Some practical considerations. Journal of Forensic Sciences, 30(4), 1179-1185.
Tsushima, W. T., & Wedding, D. (1979). A comparison of the Halstead-Reitan Neuropsychological
Battery and computerized tomography in the identification of brain disorder. Journal of Nervous
and Mental Disease, 167(11), 704-707.
U.S.v. Hinckley (1982). Criminal case no. 81-306, U.S. District Court for the District of Columbia.
Volavka, J., Martell, D. A., & Convit, A. J. (1992). Psychobiology of the violent offender. Journal of
Forensic Sciences, JFSCA, 37(1), 237-251.
Volkow, N. D., & Tancredi, L. (1987). Neural substrates of violent behavior: A preliminary study
with positron emission tomography. British Journal of Psychiatry, 151,668-673.
Wasyliw, O. E., & Cavanaugh, J. L., Jr. (1989). Simulation of brain damage: Assessment and decision
rules. Bulletin of the American Academy of Psychiatry and the Law, 17(4), 373-386.
Weiger, W. A., & Bear, D. M. (1988). An approach to the neurology of aggression. Journal of Psy-
chiatric Research, 22(2), 85-98.
Weiter v. Settle, 193 F.Supp. 318 (W.D. Mo. 1961).
West, L. Y. (1981). Discrimination of violent and nonviolent inmates with the standardized Luria-
Nebraska neuropsychological battery. Dissertation Abstracts International, 42(10), 4218.
Whelihan, W. W., & Ivans, R. (1981). Clinical neuropsychology and brain-behavior relationships.
Pennsylvania Law Journal Reports, 4, 5.
Wilson v. U.S., 391 F2d 460 (D.C. Cir. 1968).
Wood, R. L. (1984). Behavior disorders following severe brain injury: Their presentation and psy-
chological management. In N. Brooks (Ed.), Closed head injury: Psychological, social, and family
consequences. New York: Oxford University Press.
Yeudall, L. T. (1977). Neuropsychological assessment of forensic disorders. Canada's Mental Health,
25(2), 7-15.
Yeudall, L. T., Fedora, O., & Fromm, D. (1987). A neuropsychosociai theory of persistent criminal-
ity: Implications for assessment and treatment. In R. W. Rieber (Ed.), Advances in forensic
psychology and psychiatry (Vol. 2). Norwood, NJ: Ablex.
Yeudall, L. T., and Fromm-Auch, D. (1979). Neuropsychological impairment in various psychopatho-
logical populations. In J. Gruzelier & P. Flor-Henry (Eds.), Hemisphere asymmetries of function
in psychopathology. Amsterdam: Elsevier/North-Holland.
Yeudall, L. T., Fromm-Auch, D., and Davies, P. (1982). Neuropsychological impairment in persistent
delinquency. Journal of Nervous and Mental Disease, 70, 257-265.
Yeudall, L. T., Reddon, J. R., Gill, D. M., & Stefanyk, W. O. (1987). Normative data for the Hal-
stead-Reitan neuropsychological tests stratified by age and sex. Journal of Clinical Psychology,
43(3), 346-367.
Ziskin, J., & Faust, D. (1988). Coping with psychiatric and psychological testimony (4th ed). Marina
del Rey, CA: Law and Psychology Press.