Are feigning screens “competent to stand trial”? A systematic review and meta-analysis of the Miller Forensic Assessment of Symptoms Test, Atypical Presentation Scales, and Structured Inventory of Malingered Symptomatology.

Abstract

Objective: Competency to stand trial evaluations represent the most common psycho-legal assessment in the United States. Notwithstanding, evaluators may face additional complexity when they suspect malingering or overreporting of psychopathology. Despite the importance of routine screening for overreporting, there remains a lack of consensus regarding the most appropriate screening tool for this context. This systematic review and meta-analysis sought to evaluate the utility of three commonly used screening tools—Miller Forensic Assessment of Symptoms Test (M-FAST), Evaluation of Competency to Stand Trial–Revised Atypical Presentation (ATP) Scales, and Structured Inventory of Malingered Symptomatology (SIMS)—in differentiating defendants who overreport psychopathology from those who do not (“comparators”) in competency to stand trial evaluations. Hypotheses: We hypothesized that all three tools would significantly discriminate between overreporters and comparators, with the ATP Scales demonstrating the largest effect size, and each tool would demonstrate high sensitivity but moderate specificity at their recommended cutoffs. Method: We examined 14 research reports with 20 effect sizes, comprising a total of 1,929 participants (Mage = 31.22, SD = 3.98). Results: Findings showed that the pooled effect sizes for the M-FAST (k = 13, g = 2.75, 95% CI [2.18, 3.32]), ATP Scales (k = 5, g = 1.96, 95% CI [1.37, 2.54]), and SIMS (k = 2, g = 2.99, 95% CI [2.50, 3.48]) were all very large, far exceeding standards for interpreting effect sizes in malingering research. Owing to a paucity of data, further analysis of the SIMS was not feasible. Moreover, the M-FAST and ATP Scales demonstrated psychometric utility as screening tools, with sensitivity rates of .87 and .91, respectively. Conclusions: Both the M-FAST and ATP Scales appear to be effective screening tools for identifying examinees who do not require further symptom validity testing. However, considering the elevated false positive rate, positive results necessitate follow-up assessment. (PsycInfo Database Record (c) 2026 APA, all rights reserved)