Tanisha Hill-Jarrett
Forensic Neuropsychology
Summary Case Formulation: Kevin Blackmon
(a) Case Scenario
Mr. Kevin Blackmon is a 21-year-old, right-handed, Caucasian male who was evaluated
at the request of Roger Davis, Ph.D. (clinical neuropsychologist) of North Florida Evaluation and
Treatment Center (NFETC). Mr. Blackmon has a history of severe traumatic brain injury (TBI)
resulting from a motor vehicle accident on April 24, 1994. Since the accident, Mr. Blackmon
reported experiencing neurobehavioral changes and difficulties with emotion regulation that
were consistent with organic personality changes secondary to TBI. He has been arrested on
two occasions post-accident and has been unable to maintain steady employment. Mr.
Blackmon’s current legal charges include armed kidnapping, sexual assault, and battery. He
was declared incompetent to stand trial on February 5, 1999 and was subsequently sent to
NFETC for restorative treatment. The current neuropsychological evaluation is requested to
provide updated information regarding Mr. Blackmon’s post-intervention neurocognitive status,
and to assist with determination of his present competency to stand trial. The evaluation
occurred over a two-day period (April 19 and April 20, 1999), approximately 5 years post TBI.
Additional Relevant Background: Review of medical records indicates that Mr. Blackmon
sustained a severe TBI and a series of orthopedic injuries on April 24, 1999 as a result of a
motor vehicle accident in which he was the restrained passenger. At the accident scene, he was
found unconscious, decerebrate, and he had nonreactive pupils. He was treated at Hollywood
Memorial Hospital. Medical records indicated an initial Glasgow Coma Scale (GCS) score of 4,
and a negative CT (with a 5 mm lesion suggestive of axonal shearing). Mr. Blackmon remained
comatose for three weeks and received six weeks of intensive inpatient rehabilitation. He
reported persistent neurobehavioral deficits (impulsivity, difficulty controlling anger), right
hemiparesis, and occulomotor difficulty, and scanning cerebellar speech. Following
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rehabilitation, Mr. Blackmon reported continued difficulties with behavioral and emotion
regulation; he described being easily frustrated and “short fused,” and was resultantly placed on
100 mg of Zoloft.
After being released from the hospital, Mr. Blackmon returned to high school. He was in
regular classes prior to the accident, but required ESE classes for the 12th grade and was able
to graduate on time. Upon graduation, Mr. Blackmon pursued vocational education at Sheriden
Vocational Technical Center, but quit after several months of taking drafting courses due to
difficulty with completing the required mathematics. He has also been unsuccessful at
maintaining steady employment and reported being released from four out of six attempted jobs.
Mr. Blackmon reported an unremarkable pre-injury mental health/psychiatric history;
however, since the alleged offenses, Mr. Blackmon has been treated at Florida Institute of
Neurological Rehabilitation (March - June 1998) and Bridge Rehabilitation facility (1998). He
was also held for a period of time on the psychiatric unit at the North Broward Detention Center
(December 1998) prior to his initial competency hearing.
(b) Brief Statement of Legal Questions
Since being released from the hospital after the accident, Mr. Blackmon has been
arrested on two occasions. The first incident occurred on June 11, 1997, when Mr. Blackmon
allegedly met with a 16-year-old female in a mall parking lot. The female reportedly willingly
returned to Mr. Blackmon’s car with him in the parking lot. Police records indicate that at the
time of the incident, Mr. Blackmon brandished a knife and forcibly detained the female in the
car, requesting oral sex from her. The sexual act reportedly occurred and then Mr. Blackmon
released the female from the vehicle. The female called the police and Mr. Blackmon was
incarcerated for 30 days before being release on bond.
The second offense occurred on February 14, 1998. Mr. Blackmon was reportedly
meeting a woman from church for dinner. After dinner, the two reportedly returned to Mr.
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Blackmon’s car so that Mr. Blackmon could drive the woman to her car in the parking lot. Police
records indicate that when the woman proceeded to exit Mr. Blackmon’s car, he grabbed her
breast to pull her back in the car, and stated “you’re not going anywhere.” Mr. Blackmon
reportedly screamed obscenities as the woman attempted to escape the car. He then forced
her head into his lap. The woman’s screams reportedly alerted bystanders, who approached
the car and then notified the police.
For both of the offenses, Mr. Blackmon is charged with the following: armed kidnapping,
sexual assault, and battery. He was evaluated by a number of healthcare professionals prior to
being tried for these offense and was deemed incompetent to stand trial on February 5, 1999.
Mr. Blackmon has been treated at NFETC since that time.
The issue of Mr. Blackmon’s competence to stand trial has been raised for a second
time since having received restorative treatment. Thus, evaluation of his competence to
proceed is the purpose of the current evaluation. According to the Dusky standard, (Dusky v.
United Sates, 362 U.S. 402, 1960), a defendant must meet the following two-pronged criteria to
be determined competent to proceed to trial:

The capacity to understand the criminal process, including the role of the participants in
that process (understanding of proceedings – both rational + factual)

The ability to function in that process, primarily through consulting in the preparation of
a defense (ability to consult counsel)
Regarding the current competency issue at hand, Mr. Blackmon was evaluated by Tonia L.
Werner-Johnson, M.D., and Richard A. Greer, M.D. of the University of Florida Forensic
Psychiatry, who finds Mr. Blackmon competent to stand trial for the offenses. A second opinion
was provided by Antoinette R. Appel, Ph.D. (forensic neuropsychologist), who finds him
currently incompetent to proceed, and suggests that Mr. Blackmon would benefit from a further
course of treatment at Florida Institute of Neurological Rehabilitation. Dr. Appel indicated that
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continued treatment at NFETC is contraindicated because the facility does not have the
appropriate treatment program for Mr. Blackmon’s behavioral changes.
(c) Summary of Findings
*NOTE: For purposes of brevity, not all test results are discussed in detail and some sections
may contain a summary of results. A table with evaluation data can be found in Appendix A.
Interview

Understanding of the Proceedings: When queried about his charges, Mr. Blackmon
reported “armed sexual battery, armed kidnapping, aggravated battery, false
imprisonment, and simple battery.” He denied that he did anything wrong in either of
the two incidents. Mr. Blackmon was able to describe the appeal process as well as
the range of sentencing possibilities (probation through life imprisonment) and their
implications. Mr. Blackmon also described that each of the charges are independent
of one another. He was also able to state that the court trial is decided by the jury’s
decision. He referred to the judge as being a “referee who makes sure there’s a fair
trial by listening to both sides.”

Ability to Assist Counsel: Mr. Blackmon successfully provided the name and contact
information of his public defender, Hilliard Moldof. He successfully identified Stephanie
Newman as the state attorney, and stated “she’s trying to put me in prison – she’s against
me.” He said he was uncertain about the timeframe of future trials, stating “my attorney
doesn’t talk to me about stuff.” When asked about his role in the court proceedings, Mr.
Blackmon sated “if someone tells a lie, I should tell my attorney.”
Behavioral Observations: Mr. Blackmon arrived to the evaluation accompanied by his
corrections officer, who remained outside of the testing room during the course of the
evaluation. Mr. Blackmon was cordial upon greeting, but initially seemed guarded during
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interview although cooperative. His affect was flat, but overall appropriate. He became more
detailed and forthcoming with information as the evaluation progressed. He appeared to put
forth good effort on all test items, and cursed on several instances during challenging tasks.
Motor tasks were completed with Mr. Blackmon’s biologically non-dominant left hand given his
apparent right hemiparesis. He completed four hours of testing on the first day due to fatigue,
and returned to complete the remainder the following day. He periodically exhibited poor
impulse control (e.g., turning pages of test material), but his behavior was not excessive or
aggressively inappropriate. Overall, results are thought to reflect Mr. Blackmon’s current
neurocognitive status.
Intellectual Ability and Academic Achievement: Review of Mr. Blackmon’s IQ
documentation from previous evaluations indicates FSIQ performances ranging from low
average to average. The greatest post-injury recovery gains were made within the domain
of fluid intelligence. Current intellectual abilities estimated using the WAIS-R indicated an
average FSIQ (WAIS-R FSIQ = 102, 55th percentile), and equally developed verbal (Verbal
IQ = 101, 53rd percentile) and non-verbal (Performance IQ = 104, 63rd percentile) abilities.
His performance on the WRAT-3 suggests that his current word reading ability is a 12th
grade equivalent (SS=109, 73rd percentile), consistent with his level of educational
attainment.
Attention, Working Memory, and Processing Speed: On tasks of attention and working
memory, Mr. Blackmon demonstrated an auditory digit span of 8 digits forward and 5 digits
backward, resulting in a total auditory span that was within the average range (WAIS-R
Digit Span Total = 63rd percentile). Reliable digit span was 12, suggestive of adequate
effort at the time of testing. With regard to processing speed performance, Mr. Blackmon
used his biologically non-dominant left hand on the following speeded motor tasks given
his right-sided hemiparesis. As a result, scores may be an underestimation of true
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processing speed abilities. Nevertheless, results were generally within acceptable limits.
Timed numeric sequencing performance was average and without error (Trail Making
Test- Part A = 61st percentile), and symbol coding abilities were low average WAIS-R
Digit Symbol = 16th percentile).
Memory and Learning: Findings of the memory evaluation suggest that Mr. Blackmon exhibits
rapid forgetting of verbal information when provided in an unstructured format (CVLT Short
Delay Free Recall = 50th percentile; CVLT Long Delay Free Recall = 2nd percentile).
Performance was disproportionately improved during recognition testing (Delayed Recognition
Hits = 50th percentile; Delayed Recognition False Positives = 50th percentile), which is
suggestive of difficulties with the retrieval aspect of memory. Memory and learning of structured
verbal content is intact. Visual memory is intact as well and appears to be a relative strength
within the memory domain.
Executive Functioning and Abstract Reasoning: Set shifting performance on Trail Making
Test-B was below average (13th percentile), and notable for two set loss errors. Verbal
abstract reasoning was average (WAIS-R Similarities ss=10, 50th percentile). Wisconsin Card
Sorting Test performance was average (6 out of 6 card sorts). Perseverative responses (28th
percentile), perseverative errors (26th percentile), and total errors (32nd percentile) were all
within the average range. Performance on the Booklet Category Test improved and indicated
superior overall performance relative to matched-peers, with Mr. Blackmon only committing 7
errors across all 7 trials (99th percentile). Mr. Blackmon’s performance within this domain
suggests mild difficulties with set-shifting within the context of grossly intact executive
functioning. Results reflect intact flexible thinking, planning, and reasoning.
Motor Functioning: Finger tapping performance was impaired for his dominant (right) hand
(1st percentile), which is expected given Mr. Blackmon’s right hemiparesis resulting from the
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accident. Non-dominant (left) tapping performance was average (37th percentile). Motor
planning was assessed using the Luria paradigm. He committed two errors on Contrasting
Motor (WNL), and no errors on Go-No-Go (WNL). Consistent with his brain injury, Mr.
Blackmon exhibits residual right-sided motor weakness that affects speeded motor
performance. Motor programming is intact.
Visuospatial, Visuoperceptual, and Visuoconstructional Skills: Mr. Blackmon’s overall
performance within this domain was average. He exhibited average facial recognition and
matching (Facial Recognition Test = 41, 72nd percentile) and visuospatial ability (Judgment of
Line Orientation = 26, 56th percentile). Mr. Blackmon’s copy of the Rey Osterrieth Complex
Figure was within appropriate limits.
Language and Language-Related Skills: Performance on language measures indicate
impairments localized to temporal lobe language networks (semantic fluency = 5th percentile).
Naming, letter fluency and grammar/syntax abilities were within normal limits.
Self-Reported Personality and Emotional Function: Results of the MMI-2 revealed a Welsh
code of 4”6389’12+-7/05: F-LK/. Validity scales were within an acceptable range and suggest
that Mr. Blackmon did not attempt to exaggerate or minimize symptoms. His response pattern
was generally consistent. Clinical scale elevations indicate that Mr. Blackmon has some
concern with somatic symptoms and his physical well-being, which is in accordance with the
nature of his injuries. Results suggest that Mr. Blackmon’s stress symptoms tend to manifest
physically. His response pattern is suggestive of depressive symptoms including feelings of
uselessness, poor initiation, and hopelessness. This profile also is reflective of an individual
who has deviated from societal standards through his actions and defiance, and responds to
others with suspiciousness and feelings of persecution. Overall, Mr. Blackmon’s responses
indicate poor coping strategies and poor anger management/impulse control.
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(d) Final Opinion
Comparing results to his other evaluations since injury, Mr. Blackmon has made an
outstanding recovery given the magnitude of initial brain impairment. Results of the current
testing primarily reflect a profile remarkable for residual frontal and temporal lobe injury. From a
cognitive standpoint, findings suggest temporal lobe dysfunction affecting memory retrieval of
unstructured verbal information. Impaired semantic fluency was further suggestive of temporal
lobe impairment. Mr. Blackmon’s performance on simple tasks of attention and working
memory, letter fluency, vocabulary, visual memory, visuospatial and construction skills, were
within normal limits. There was evidence of residual right-sided motor weakness affecting
speeded motor performance.
Behaviorally, Mr. Blackmon’s reports experiencing persistent neurobehavioral
disturbance, resulting in low frustration tolerance, disinhibited behavior, and previous acts of
aggression. During both days of neuropsychological evaluation, Mr. Blackmon’s behavior was
well-regulated and within reason despite the challenging cognitive tasks he faced. He was wellmannered and able to recognize his personal limits as evidenced by his request to complete
testing the following day. Additionally, measures of frontal-executive functioning indicate that
Mr. Blackmon is capable of thinking flexibly and incorporating information to provide adaptive,
appropriate responses. He showed good effort on tests regardless of difficulty.
Self-report measures suggest that Mr. Blackmon continues to experience symptoms of
depression, has poor coping skills, and difficulties managing anger. His responses indicate mild
paranoia regarding future outcomes and feelings of persecution
Opinions Regarding Competency: In my opinion, based on the relevant evidence and
neuropsychological test results discussed above, Mr. Blackmon is deemed competent to
stand trial. He appears capable of serving the role of the defendant in criminal proceedings,
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but would likely benefit from breaks if required to provide extensive testimony. This
competency opinion was substantiated by the following pieces of evidence:

Appreciation of charges or allegations; appreciation of range and nature of
penalties: Based the information acquired in clinical interview (discussed above), Mr.
Blackmon was able to correctly cite his charges as well as plea options and their
associated outcomes.

Understanding of adversarial nature of the legal process: Mr. Blackmon correctly
named and discussed the roles of those involved in court proceedings (attorney,
prosecutor, judge, and jury) and demonstrated understanding of their respective roles. He
described the opposing attorney as “being against him,” demonstrating his recognition of
the adversarial nature of the legal proceedings.

Disclose to counsel facts pertinent to the proceedings at issue: Results of
neuropsychological testing also suggest that Mr. Blackmon possesses the cognitive skills
(i.e., intact processing speed, abstract thinking, language, and memory) necessary to
consult with his attorney in a meaningful manner to assist in his defense. Although he
does not agree with his charges, he was capable of providing a detailed account of the
events leading to the alleged crimes that were generally consistent with the information
included in the police report. While there was evidence of paranoia regarding the case,
Mr. Blackmon expressed belief that his lawyer is “on his side” suggesting that the
maintenance of collaborative relationship with his attorney is possible.

Manifest appropriate courtroom behavior: Mr. Blackmon appears capable of
managing and regulating his behavior in a professional manner when explicitly required,
such as during the neuropsychological evaluation. While occasionally impulsive during
testing, Mr. Blackmon was not disruptive and in no way was his behavior unmanageable
or threatening. He was aware of when he was reaching his performance threshold
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(suggesting intact monitoring abilities), and requested to complete testing the following
day. Additionally, he appears generally motivated to assist in court proceedings given his
proclaimed innocence during the clinical interview, and would therefore likely be more
cooperative and compliant.

Testify relevantly: Current test results suggest that Mr. Blackmon exhibits weakness in
auditory memory and therefore may have trouble retaining large volumes of auditory
information presented in the courtroom. This does not preclude him from competency to
stand trial, however. Given his spared visual memory abilities, he would likely benefit
from receiving pertinent information that he must retain in written format. If required to
testify, Mr. Blackmon should be permitted to take written notes while on the stand.
Additionally, he appears to possess accurate memory of the events leading up to the
alleged crimes.
(e) Self Evaluation of Testimonial Effectiveness
Going into the experience, I felt very confident in my opinion from the evaluation;
however, I found testifying to be initially nerve-wracking (even with the support of my peers),
which I think ultimately influenced my effectiveness and ability to deliver the facts in a
persuasive manner. I tend to be a person who has anticipatory anxiety, so this experience was
not an exception.
From the experience, I found that regardless of how compelling and articulate the
argument is on paper, delivery of testimony to the jury is crucial and likely the only thing that
the jury will remember. I personally felt that I had a hard time with explaining the most basic of
neuropsychology concepts such as “frontal lobe syndrome” and “perseveration” without using
technical jargon. If this were a real courtroom setting, not only would I have lost the audience
when I begin using overly technical terms, but I would have discredited myself in the process of
struggling/fumbling to come up with a decent explanation that is appropriate for the layman.
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Also in my naivety, I was not aware that the line of cross-examination would take the
direction that it did. I was first asked to discuss the results of the MMPI-2, which was not
problematic. Then, I was asked specifically about the standardization sample (which I had a
vague idea of what I thought was a correction answer, but was not sure at the time) and was
immediately discredited, because I appeared to be using a measure that I do not have full
understanding of. At one point, I also recall being asked about my opinion on another
professional’s evaluation of the defendant. As the professional’s opinion was one that I clearly
disagreed with, I think that I should have taken more precaution to convey my disagreement in
a tactful manner instead of outright stating that I disagreed with it. This has certainly made
more aware of some of the “traps” that lawyers use (e.g., asking directly whether I agree or
disagree with the professional’s opinion).
There was also a sense that I needed to be “one step ahead” of the opposing counsel,
but even when I anticipated questions, I found that the information I provided was used against
me. For example, when asked about TBI patients, I stated that it is not uncommon for them to
need regular breaks due to fatigue, therefore the defendant’s request to divide the day into two
testing sessions was not out of the ordinary. But then when asked how many TBI patients that I
have personally seen for clinic actually request a break (only one out of about ten), I again
appeared to have contradicted myself.
Overall, I felt that I did a decent job of using Mr. Blackmon’s data and behavioral
observations as evidence of his competence. I also tried to emphasize the fact that his present
presentation suggests that he is competent despite historical accounts of his past
behaviors/interactions, as competency is an issue of the person’s current mental and emotional
status. I was unaware of this at the time, but I evaded a trap by stating that I do not consult any
specific book when I developing my opinion about the defendant.
Overall, I think that while my written argument was strong, my testimony was not as
effective. I think the experience is general most certainly a lesson in flexibility and logic. It has
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also helped me to reflect things on my communication style, and has emphasized the
importance of simplicity and conciseness even when outside of the courtroom (e.g., when
communicating research or any information to an unfamiliar audience).
95 – VERY GOOD PAPER!!
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Appendix A
INTELLECTUAL FUNCTIONING
WAIS-R FSIQ
Verbal IQ
Information
Comprehension
Vocabulary
Similarities
Arithmetic
Digit Span
Performance IQ
Block Design
Object Assembly
Digit Symbol
Picture Arrangement
Picture Completion
ACADEMIC ACHIEVEMENT
WRAT3 Reading
ATTENTION & WORKING MEMORY
WAIS-R Digit Span
Forward Span
Backward Span
PROCESSING SPEED
WAIS-R Digit Symbol
Trail Making Test
Part A
LEARNING & MEMORY
CVLT
Trial 1
Trial 5
Total
Short Delay Free Recall
Short Delay Cued Recall
Long Delay Free Recall
Long Delay Cued Recall
Delayed Recognition Hits
False Positives
WMS-R Logical Memory
Immediate Recall
Delayed Recall
WMS-R Visual Reproduction
Immediate Recall
Delayed Recall
Rey Complex Figure
Raw
Score
15
19
33
20
19
18
41
34
46
14
19
Raw
Score
51
Raw
Score
18
8
5
Raw
Score
46
21”(0 er)
Raw
Score
Ss
SS=102
101
8
9
7
10
15
11
104
12
11
7
10
14
%ile
55
53
25
37
16
50
95
63
63
75
63
16
50
91
Descriptor
Average
Average
Average
Average
Low Average
Average
Superior
Average
Average
Average
Average
Low Average
Average
Above Average
SS
SS=109
%ile
73
Descriptor
Average
Ss
ss=11
---
%ile
63
---
Descriptor
Average
---
ss/T
7
%ile
16
Descriptor
Low Average
T=53
61
Average
z/T
%ile
50
<1
7
50
16
2
2
50
50
Descriptor
8
10
49
12
12
9
10
>16
0
0
-4
T=35
0
-1
-2
-2
0
0
Average
Impaired
Below Average
Average
Low Average
Impaired
Impaired
Average
Average
26
16
---
41
22
Average
Low Average
36
27
---
70
22
Average
Low Average
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Immediate Recall
Delayed Recall
LANGUAGE
BNT
COWA
FAS
Animals
VISUOPERCEPTUAL, VISUOSPATIAL,VISUOCONSTRUCTION
Benton Facial Recognition
Judgment of Line Orientation
Rey Complex Figure: Copy
Copy Time
EXECUTIVE FUNCTIONING
Trail Making Test
Part B
WCST
# Categories
Perseverative Responses
Perseverative Errors
Total Errors
Booklet Category Test
# Errors (subtests 1-7)
MOTOR FUNCTIONS
Finger Tapping Test
Right Hand (Dominant)
Left Hand (Non-Dominant)
Luria Motor Programmes
Contrasting Motor
Go-No-Go
MMPI-2/ T-score
L
56
Pd (4)
F
64
Mf (5)
K
56
Pa (6)
Hs (1) 68
Pt (7)
D (2) 68
Sc (8)
Hy (3) 76
Ma (9)
Si (10)
118”
85”
Raw
Score
54
WNL
WNL
T-Score
44
%ile
27
Descriptor
Average
50
34
50
5
Average
Impaired
T-Score
%ile
72
56
T
%ile
Descriptor
Average
Average
WNL
WNL
Descriptor
39
13
Below Average
6
10
10
18
Z=0.08
Z= -0.57
Z= -0.63
Z= -0.48
53
28
26
32
Average
Average
Average
Average
7
Raw
T=76
Z
99
%ile
Superior
Descriptor
31.8
46.4
-2.24
-0.32
1
37
Impaired
Average
43
15
Raw
Score
41
26
117”
Raw
80”(2 er)
2er
0er
WNL
WNL
82
42
79
57
72
72
44
Welsh Code: 4”6389’12+-7/05: F-LK/
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