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Personality and Individual Differences, 35,1439–1462.EVALUATION OFCOMPETENCE TO
STANDTRIAL–REVISED(ECST–R)
Evaluation of Competency to Stand Trial–Revised
(ECST–R) is a semistructured interview that is designed
to assess criminal defendants’ capacities as they relate
to courtroom proceedings. In Dusky v. United States
(1960), the U.S. Supreme Court established the three
basic prongs required for competency to stand trial:
(1) factual understanding of the proceedings, (2) ratio-
nal understanding of the proceedings, and (3) rational
ability to consult with counsel. The ECST–R was
developed and validated for assessment of the Dusky
prongs. In addition, the ECST–R includes a specific
screen for feigned incompetency.Description and Development
Prototypical analysis with competency experts identi-
fied core representative items for three ECST–R com-
petency scales: Factual Understanding of the Courtroom
Proceedings (FAC), Rational Understanding of the
Courtroom Proceedings (RAC), and Consult with
Counsel (CWC). Prototypical items were also evaluated
by trial judges and highly experienced forensic psychia-
trists. In addition to competency scales, the ECST–R
uses multiple detection strategies for validating its four
Atypical Presentation (ATP) Scales: Psychotic (ATP–P),
Nonpsychotic (ATP–N), Both (ATP–B; sum of ATP–P
and ATP–N), and Impairment (ATP–I). A fifth ATP
scale is not used to assess feigning, but masks the intent
of the other ATP scales: Realistic (ATP–R).
Samples from four major studies were combined
for normative data and test validation. Three samples
consisted of mentally disordered offenders: (1) 100
detainees on a psychiatric unit of a large metropolitan
jail, (2) competency cases including 28 pretrial evalu-
ations and 42 inpatients in competency restoration, and
(3) 56 inpatients in competency restoration. They were
supplemented with 95 jail inmates and 89 additional
competency referrals.Reliability
Internal consistencies (alpha coefficients) were high for
overall competency (.93) and the individual compe-
tency scales: FAC (.87), RAC (.89), and CWC (.83).
Interrater reliabilities were exceptional for these com-
petency scales: FAC (.96), RAC (.91), and CWC (.91).
Even when focusing on individual competency items,
interrater reliabilities remained strong (Mr=.77). In
addition, most individual competency ratings remained
stable across a 1-week interval with more than 90% of
the ratings remaining identical. ATP scales had moder-
ate to high internal consistencies (alphas from .70 to
.87) with the exception of ATP–R (.63), which serves a
different purpose. ATP scales have outstanding inter-
rater reliabilities (rs from .98 to 1.00)Validity
The previously described prototypical analysis pro-
vided strong evidence of content validity. For con-
struct validity, confirmatory factor analyses were used
to test various models of the Dusky prongs for the
ECST–R competency items. With one cross-loading,
the confirmatory factor analyses confirmed a three-
factor model with high loadings (M=.72) for compe-
tency items on their designated scales.
For criterion-related validity, ECST–R competency
scales demonstrated a high concordance with inde-
pendent opinions of experienced forensic experts and
legal outcomes. It also evidenced moderate correla-
tions with the MacCAT–CA, despite major conceptual
differences between the two competency measures. In
addition, very large effect sizes were found between
defendants with and without impairment on ECST–R
competency scales for both the severity of psychotic
symptoms (Cohen’s ds from 1.95 to 2.98) and overall
functioning (ds from 1.60 to 1.75).
The ATP scales were validated using a combination
of known-group comparisons and simulation designs.
Both suspected malingerers and simulators produced
much higher scores than genuine inpatients on the
ATP scales with the logical exception of ATP–R. Very
large effect sizes were found for both suspected
malingerers (Md=1.99) and simulators (Md=1.74).Forensic Applications
The ECST–R is a second-generation competency mea-
sure that was carefully constructed and validated to eval-
uate the Duskyprongs, which applies to competency266 ———Evaluation of Competence to Stand Trial–Revised (ECST–R)E-Cutler (Encyc)-45463.qxd 11/18/2007 12:42 PM Page 266