Accused Child Killer Had Impaired Memory: Forensic Psychologist

Added: 2026-05-12

[00:00:00]Go ahead, buddy. Okay. Morning, doctor.

[00:00:02]>> Morning.

[00:00:05]>> Could you introduce yourself to the jury, please?

[00:00:07]>> Uh, my name is Dr. Courtney Andress.

[00:00:10]>> Could you spell that last name for the record, please?

[00:00:12]>> E N D Res.

[00:00:14]>> Um, what do you do for a living?

[00:00:16]>> I'm a forensic psychologist.

[00:00:18]>> And what generally is a forensic psychologist? Uh generally we do evaluations of individuals although sometimes uh we we essentially educate the court on matters of psychology as they pertain to the law. So that usually involves an evaluation of a person although sometimes I do what's called expository testimony where I just talk about uh various issues uh that may apply to an aspect of the case.

[00:00:42]>> Sure. Um do you have a curriculum curriculum vet that you prepared?

[00:00:46]>> I do. And I'm going to show you.

[00:00:53]>> Thank you.

[00:01:11]>> Does that document look familiar?

[00:01:12]>> It does.

[00:01:13]>> And does that appear to be your current curriculum, Vite? Uh, I think there's a couple of things that need to be updated. Some continuing education that I've taken since then, but the the bulk of it is correct.

[00:01:24]>> Sure. Um, generally speaking, does it accurately reflect your education and training?

[00:01:29]>> Yes, it does.

[00:01:30]>> Offer 274, your honor.

[00:01:32]>> No objection.

[00:01:33]>> Received.

[00:01:34]>> So, Dr. uh um could you briefly summarize your education leading to your career as a forensic psychologist?

[00:01:41]>> Sure. I have an undergraduate degree in clinical psychology and then I also have a a master's in doctoral degree uh in clinical psychology. I did my forensic specialization with my uh pre and postdoal uh positions.

[00:01:56]>> So you specialize in forensic psychology in your fellowship.

[00:02:00]>> Correct.

[00:02:00]>> All right. Um and can you summarize your your current practice for us briefly?

[00:02:06]>> Uh so I've had an independent forensic practice since 2012. I do primarily criminal work. So, uh I work on uh NGI or insanity cases, competency issues. Um I also do a small amount of civil uh work with guardianships and protective placements. Uh and then just answering general questions about uh psychology as they may pertain to to uh issues in the law.

[00:02:32]>> Are you currently licensed to practice psychology in Wisconsin?

[00:02:34]>> I am.

[00:02:36]>> And has that license been maintained and active in good status? Yes.

[00:02:40]>> All right. So, did you evaluate Josie Dykeman at my request?

[00:02:45]>> I did.

[00:02:45]>> What generally was the scope of your evaluation?

[00:02:49]>> Uh I was told that uh she had some head injuries and so uh you asked that I evaluate her to determine whether or not there was any impact from a possible traumatic brain injury. Uh just to essentially look at her neuroscychological status. also to look at some emotional behavioral components that might be the result of some reported domestic abuse. So to essentially do some diagnostic testing with her, interviewing, make diagnoses and talk about her functioning as those things may impact it.

[00:03:22]>> Did I also ask you to uh um offer some expositional testimony on domestic violence generally?

[00:03:27]>> Yes.

[00:03:28]>> Sure. Um so did you meet with Miss Dykeman?

[00:03:30]>> I did. And uh can you tell us uh generally how or what you were doing in that evaluation?

[00:03:36]>> Uh so I interviewed her about her background uh history. We did quite a lot of psychological testing. Um and I so I think subsequent to actually meeting with her I did also review some medical records.

[00:03:52]>> Okay. Did you um were the records that were reviewed or those common um in your course of review? Your honor, I object to her discussion of the medical records that was not disclosed to us or contained as something that she reviewed in her report.

[00:04:06]>> Judge, I filed this as a a 40day hearsay notice. It's >> hearsay, but we weren't noticed that Dr. Andres reviewed them or that she was going to testify regard them regarding them, judge. So, I'm not saying that the records are hearsay um given the notice, just that her testimony on them was not noticed and therefore shouldn't be allowed. It's not required by the expert know statute judge.

[00:04:30]>> Over. Go ahead.

[00:04:32]>> Um, were the records reviewed uh common in the common records to review in the scope of your evaluation?

[00:04:37]>> Yes, sir.

[00:04:38]>> Can we be heard on this?

[00:04:43]>> Um, yeah.

[00:05:49]Judge, for the record, uh, Attorney Zacher's notice of expert testimony, um, was filed as document 88. Um, Miss Andre's report, which I don't believe has been offered yet, um, was also filed as document 115 in this case. Um, from my review, neither of these reflect either that she reviewed the medical records or that there would be testimony related to Miss Egman's medical records um, in either the report or the notice.

[00:06:24]>> Judge, what did the state think we were going to do when we noticed Dr. lists um certified report of August 13 of 2021 um as a certified medical record intended to use in Miss Dyken's case and chief >> I don't I don't think that's my job your honor to come up with every possibility it could have been used for a variety of witnesses in this case >> this is why your honor we asked for the dober hearing um originally related to Miss Andres so that we could go into um what relied on in her opinions and the methodology for how she came to those opinions, including what record she reviewed and considered.

[00:07:08]>> Judge, the uh the notice was clear. The uh court did not require a downward hearing because the notice was clear. Um this is standard stuff. It was noticed as a hearsay exception, Dr. List report.

[00:07:23]um that this I I find it ironic that the state is accusing us of not providing full and fair discovery when we got um literal stacks of unnoticed text messages and summaries um just this last week.

[00:07:39]>> And I'm going to take um an issue with the last statement attorney Zacher just made. He had all of those text messages in discovery, your honor. again um has been previously stated this isn't a you know tick for tat thing nowhere in the notice of expert does it discuss um the testimony related to Miss Dykeman's medical records in any way >> in the notice in the notice uh specifically in well not in the notice in the report by Dr. Anders, there's a paragraph two uh uh says Dr. Anders will testify to how the patient uh with Miss Dykeman's how a patient with Miss Dykeman's deficits, history of trauma, and the history of becoming submissive and complacent.

[00:08:34]Um so there's already there's reflection about her history of trauma and cognitive deficits.

[00:08:40]You're saying that because they didn't say specifically medical records above in the notice or in the report that that okay that excuse me that came from the notice that was filed on November 25th, 2024.

[00:08:58]Um over a year and a half ago.

[00:09:02]Um you're saying that because they didn't write the word medical records in the above list that you did not have notice of the medical records. Is that what you're saying? The state didn't realize, oh, they're probably looking at the medical records, especially after they gave notice of the medical records.

[00:09:16]>> Well, judge, in her report, she doesn't indicate in her sources of information that she relied on the medical records in any way. So, we can make a lot of assumptions about what they're going to rely on, right, when we look at these notices of expert testimony. Um, but I think it's fair that once we have the report and the opinion of Dr. Andres and it doesn't say anywhere that she relied on the medical records when she's coming to these conclusions and then that is what is then given to us. I don't think it's fair to say we should have to guess at what they're going to provide as part of expert testimony. That's why what we have to lay out in our notices of expert testimony um I think is so stringent.

[00:10:07]Your honor, if we had known, right, that there's going that she's going to be talking about or interpreting the medical records as part of her opinion, that may have been something that we would have then gotten our own expert about if that was an issue. Judge, I'm not contesting anything about right her reporting.

[00:10:29]So, you're saying that a report you got a year and a half ago that you would have gotten an expert if you would have known her opinion?

[00:10:39]>> We don't know, judge, because we don't know what her opinion is yet. We're going to get it for the first time today.

[00:10:43]>> Her opinion in the report, right?

[00:10:45]>> Not about the medical record. She even said she subsequently after this report came out reviewed those medical records.

[00:10:51]Judge, >> is that correct? It happened after the fact. Judge, it's relevant to the issue of uh um malingering testing, but the records were 157 or document 157 where we introduced this um looks like that was e filed on July 1st of 2025, the not intent to introduce Dr. List's um report that's consistent with Dr. Anders's finding. That's that's the extent of the use of that document. Dr. This report is independently admissible under this notice, your honor. We provided the state with that notice back in July of last year um as as required. So if if you'd like, I can just um ask Dr. Andrew about Dr. List's report. Um but it's going to be admitted regardless.

[00:11:42]>> And your honor, our position is it that she considered this report after she wrote her report. Um, then it's inadmissible.

[00:11:53]>> Attorney Zacher knows that should have been noticed. Your honor, >> judge, it was completely properly noticed. This is absolutely consistent with expert notice reporting requirements.

[00:12:07]>> Okay. So, there's a report by Dr. Anders and April 4th, 2025.

[00:12:15]There was the defendant's notice of expert testimony in uh November 25th, 24.

[00:12:25]And then there was the notice uh there was the notice of intent to introduce medical records on July 1st of 25. So um I think I think the state had notice. I think this is I think the state had noticed. So I'm gonna overrule the objection. We'll bring the jury in.

[00:13:32]Everybody may be seated. Go ahead and proceed. Mr. um Zacher.

[00:13:36]>> Okay. Um thanks for your patience, doctor. So did you meet with Miss Dykeman to administer any testing?

[00:13:43]>> I did. And uh is the length of time that you met with Miss Dykeman consistent with what you would normally require to conduct the type of testing that you found to be appropriate?

[00:13:53]>> Yes, I mean it varies by individual, but um yes, it was fairly common.

[00:13:59]>> Did you review the criminal complaint before meeting with Miss Dykeman?

[00:14:02]>> I did.

[00:14:03]>> Is that common for uh professionals in your line of work to review that document?

[00:14:07]>> Yes.

[00:14:09]Um, so I'm going to cover this in greater detail and break it down, but were you able to come to any diagnostic impressions regarding Miss Dykeman after meeting with her?

[00:14:18]>> Yes.

[00:14:19]>> And what generally are your diagnostic impressions of Miss Dykeman?

[00:14:24]>> Uh, so cognitively I found that she had some significant deficits with memory and attention, uh, verbal reasoning, expressive language, uh, emotionally and psychologically. there were a lot of post-traumatic stress symptoms present uh anxiety, depression, reexperiencing.

[00:14:43]Um she the results showed that uh test results showed that she tends to view the world as a very hostile um untrustworthy place. She's very passive uh and submissive in relationships. Uh that's her tendency. Uh she also presents uh as very um we call it flat but basically a lack of emotional expression that you can visibly see um and reduced u emotional reaction to what would normally be provoking events. And what I found was that that was the result of the traumatic event she's experienced and coping with that versus someone who is callous and uncaring um about things. Um so that was significant. And then lastly, I I did look for malingering. There was I did not find that she was mingering. In fact, she often minimized her her mental health symptoms.

[00:15:41]>> Okay. And just for the record, what is malingering? What does that mean? Oh.

[00:15:45]Uh, malingering means faking or feming uh mental health symptoms for secondary gain.

[00:15:51]>> Okay. So, doctor, I'm showing you what's been marked.

[00:15:56]Did you prepare a report?

[00:15:58]>> I did.

[00:16:01]>> Take a look at that and just let me know if that appears to be a copy of the report that you submitted in this case.

[00:16:07]>> Yes, this looks to be it.

[00:16:09]>> All right. Um, are all the findings within it uh true and accurate to the best of your knowledge?

[00:16:13]>> Yes. offer 273.

[00:16:16]>> Um, >> objection, your honor.

[00:16:18]>> Received.

[00:16:20]>> Thank you. So, doctor, I want to start at kind of the top here. Um, you diagnosed Miss Dykeman with something called major neurocognitive disorder. Is that correct?

[00:16:29]>> Correct.

[00:16:30]>> What does that mean?

[00:16:31]>> So, a major neurocognitive disorder means that there are there is noted uh cognitive decline from previous functioning uh either reported by the person or by someone who knows them. Uh also uh formal testing uh has indicated that there are some cognitive impairments uh in various areas like memory, attention, executive functioning, uh social um the ability to read social cues and then all of that has to result in impairment in the person's daily functioning in various ways but uh often in act what we call ADLs or activities of of daily living um such as managing money, holding down a job, things like that.

[00:17:14]>> What tests generally did you perform to uh evaluate Miss Dykeman for that condition?

[00:17:19]>> Uh so I gave her a few neuroscychological tests.

[00:17:24]Uh the most notable was what's called the RB bands or the repeatable uh battery for the assessment of neurosychological status. And it looks at things like uh immediate memory, delayed memory, language, abstract, visual spatial skills, um attention, maybe forgetting one. Um I also gave her the Montreal cognitive assessment, which is more of a screening tool for those same types of things. It looks at executive functioning, um attention, memory, language.

[00:17:54]Uh I also administered um the for short it's called the DREFS or the delis ratings of executive functions and that looks at more of the emotional and behavioral uh components of executive functioning. So um aolition or lack of motivation uh apathy um emotional management um working memory attention uh problem solving skills things like that. Um what's executive function?

[00:18:25]>> Executive functioning refers to our higher order brain functions such as um the ability to to plan or foresee consequences, problem solve, decision making. U memory and attention is there as well, but it's really sort of those higher brain functions instead of um you know versus like the aggression and pain and pleasure, the sort of basic impulse uh that comes from different parts of our brain. Did you also administer a tool called the helps brain injury screening tool?

[00:18:53]>> Yes, I did that as well. Um the helps looks at is a screening tool just looks at different typical symptoms of people who have brain injuries. Um things like uh headaches, trouble reading, trouble calculating, um concentration and attention difficulties, depression, anxiety, uh things like that. Are these the type of uh instruments that professionals like yourself rely upon commonly in coming to conclusions about the extent of somebody's deficits?

[00:19:21]>> Uh yes, we all tend to have preferences with different tools. I would say the RB bands is is one of the most commonly used >> and uh um have these instruments been validated?

[00:19:31]>> They have.

[00:19:32]>> What does it mean to say that an instrument's been validated?

[00:19:35]>> It essentially means that it measures what it's supposed to measure. So it will look at other uh tools that claim to measure the same thing. to see if it does an adequate job. Um, it looks at different populations of people to see if it continues to measure the same thing it claims to measure. So, it's it's a process of testing, repeated testing and make sure that the test is actually doing what it says it's going to do.

[00:19:57]>> Sure. So, I know that you mentioned that the RB bands um test five distinct areas. Immediate memory, visual, spatial or constructional constructional uh perception. Yes. Um, language abilities, attention, and delayed memory. Did I get that correct?

[00:20:11]>> Correct.

[00:20:12]>> Um, I'm going to start with immediate memory. What is that?

[00:20:16]>> Um, so immediate memory is the ability to hold on to something for just a uh a minute or two, just sort of um repeat it back. So, for example, I may list 15 words and then tell you to repeat back what you can remember. So, that's testing immediate memory.

[00:20:32]>> Okay. Um, and how did Miss Dykeman score in terms of her immediate memory?

[00:20:37]>> Uh, very low. uh I believe that was one of the extremely low category. So it would have been around the the second percentile. So when you say second percentiles that means that 98% of people who also took that same test performed better than she did. And it breaks it down by age groups too. So you're not comparing a 20-year-old to an 80-year-old.

[00:20:57]>> Sure. What's delayed memory? Can you give us an example of that?

[00:21:01]>> Sure. So delayed memory, we're talking about maybe a few minutes or a few hours. on the the testing that I did, it's more like a few minutes, but basically at the beginning of the test, for example, the list of words that I mentioned that I might ask you to repeat for immediate memory, maybe 15 minutes later in a different portion of the test, I'll ask you, hey, do you remember any of those words? Then there's also another test where you you're given um options. So, was this word on the list to to look at different types of memory?

[00:21:30]But essentially, delayed is is waiting a few minutes or possibly a few hours to see if a person can remember.

[00:21:37]>> We're not talking about weeks or months or years when it comes to delayed memory.

[00:21:40]>> No, those would be long-term memories.

[00:21:43]>> And uh um how would delayed memory apply to uh being able to remember or recite events that happened hours earlier?

[00:21:52]>> How would a poor delayed memory affect that? Uh yeah, a person would have difficulty. Um they may not remember a conversation they had a few hours before, or they may remember it incorrectly. Um they're likely to forget appointments, not be able to keep track of those types of things. Um they may be forgetful in where they put things around the house, things like that.

[00:22:13]>> Now, your report indicates that Miss Dykeman tested in the extremely low range for delayed memory. Is that correct?

[00:22:19]>> Yes.

[00:22:19]>> Um what does that mean?

[00:22:22]Uh well, it means that not only is her immediate memory pretty poor, but her ability to then try to recall it later on is is even worse. It it just it deteriorates even more over time.

[00:22:34]>> Um do you even um and and you've explained the fact that uh of the 2% significance is is that broken down by age groups?

[00:22:42]>> It it is. I believe from recall I think it was like a age 20 to 36 band that she was in or somewhere around there but it's essentially uh by about 10 years or so. Once you get to the very young or very old the bands get smaller but yes essentially her same age peers.

[00:23:00]>> Generally speaking how does having um impaired memory like Miss Dykeman affect a patient on a day-to-day basis?

[00:23:08]>> You know again they're going to maybe misplace things around the house, forget where they put them. they won't remember where they're supposed to be at any given time. Um, conversations that that can be difficult because people get embarrassed. You know, they want to they don't want to admit that they've forgotten things. So, sometimes they'll they'll say they remember, but they may not remember the the full conversation.

[00:23:27]Um, just describing how things happened, telling a story that may be much more difficult for people with delayed memory issues because they they don't remember a nice chronological narrative that they can feed back to someone. So in your notes in your report with respect to delayed memory, um you had a line in there that says once meaning was attached to stimuli, Miss Degman struggled to remember anything at all.

[00:23:51]Do you recall that section?

[00:23:53]>> Yes.

[00:23:53]>> What do you mean by that?

[00:23:55]>> So um some of the tests they might give unrelated information. And so going back to that list of words, just an unrelated list of words a person may be asked to remember later versus a short story that has more meaning that has um you know their semantic value there. Well, once that was incorporated, she had much more difficulty. Usually you'll find the opposite with people and that it's easier for them to to just remember um you know things that actually they can find meaning to. We have little tricks in our brain to help us remember things when they mean something. Uh but for her that I my overall conclusion was that that overwhelmed her brain that was too much stimulus and so it was more difficult for her once it the the information had meaning to it.

[00:24:39]>> Um can we take that to mean that if uh um somebody somebody with this deficit might struggle to identify what's relevant to a conversation and produce that information?

[00:24:49]>> Oh absolutely.

[00:24:50]>> Okay. So, um I'm going to get into this in a bit more detail later, but can stressors um impede or make an already existing cognitive deficit worse?

[00:25:04]>> Yes.

[00:25:05]>> Um generally speaking, in what ways?

[00:25:08]>> Uh well, people um there have been a lot of tests that that we've done over the years researching people's memories.

[00:25:16]And if you just give a person information to repeat back backwards or back later and then compare it to um maybe incorporating a stressful event or they're trying to multitask, people generally just perform worse. Um when there's more things that are interfering with memory, other things that you're trying to sort of multitask in your brain that can become overwhelming, particularly for people that that may be not operating at the level of the norm normal population to begin with. Did you observe some of these same memory deficits in other instruments that you administered to Miss Dman?

[00:25:50]>> Yes, the memory deficits that was consistent across everything.

[00:25:54]>> All right. And I'm just going to talk briefly about the Montreal cognitive assessment. Um what does that do?

[00:26:00]>> So that's a screening tool looks at um short-term memory, uh attention, some aspects of language, abstract reasoning skills, um some visual spatial skills.

[00:26:12]And you noted that Miss Dykeman scored significantly below the normal range in um that as well. Is that correct?

[00:26:19]>> Correct. So you get a total score and then you can also look at the different areas and how people performed. And her total score would indicate that her cognitive functioning is not in the normal level. It's it's below.

[00:26:29]>> Um does the Montreal cognitive assessment also measure delayed recall?

[00:26:34]>> It does by a few minutes. Right.

[00:26:37]And were the findings of the Montreal Cognitive Assessment consistent with what you found on the RB bands?

[00:26:43]>> Yes.

[00:26:44]>> Um you described in that section Miss Dykeman's um memory deficits as quote a glaring deficit in her working memory.

[00:26:53]What is working memory and what did you mean by that? The working memory is similar to immediate recall in that it's it it's attention being able to so for example if I say um I'm going to give you a series of numbers and I want you to repeat them back but in backward order. You not only have to remember that information but you have to remember it long enough to maybe manipulate it a little bit. So working memory is just sort of that information you need to hold on to for a few minutes and maybe be able to think about in more ways than just repeating it back. Um but it's it's that ability essentially.

[00:27:25]>> So the RB bands also measures language abilities. Is that right?

[00:27:29]>> Uh it does. Yes.

[00:27:30]>> And what is expressive language?

[00:27:33]>> So expressive language as opposed to receptive language which would be what we understand. Expressive is our ability to clearly articulate our thoughts to another person. So things that could affect that might be uh a lack of extensive vocabulary. Um people with deficits there often um mix up verb tense. They will say something past tense or future tense when they mean the opposite. Um they may just not have the they have word finding difficulties oftentimes. Um and so just putting together a coherent narrative for people with deficits in expressive uh communication is difficult. Um, how can somebody with poor or how does poor expressive language abilities, how does that interact with memory functions when trying to describe events?

[00:28:19]>> Well, they exacerbate each other. I mean, if you can't you already have trouble expressing your thoughts and then you don't remember parts of the story, the story can get very confusing and jumbled and have gaps in it.

[00:28:32]>> Okay. it. Would you agree that the ability to remember um details and um identify the relevant details is necessary to the ability to explain those details to somebody else?

[00:28:43]>> Correct.

[00:28:44]>> Um your report indicate that Ms. um Dykeman scored in the extremely low range for expressive language. Is that correct?

[00:28:51]>> Yes.

[00:28:52]>> Um and just generally speaking, uh how does that manifest with Miss Dykeman?

[00:28:57]>> Uh well, specifically, I mean, it was everything from uh vocabulary. So she had word finding difficulties naming objects to verbal fluency uh just and and that was on the RB bands test just in speaking with her. It was also notable when she would try to explain things sometimes it was very confusing.

[00:29:14]She would stop she would pause and try to go back and and correct herself or fill in the details. It was just she seemed confused trying to explain things. Um so yeah it was it was evident in both testing and just talking with her. Would you expect a patient with Miss Dykeman's condition to um struggle in an interview, for instance, with police officers?

[00:29:38]>> Sure, because there's added stress there. So, I would imagine it would be worse.

[00:29:42]>> Um, how about during testimony? Would you expect somebody with her conditions to struggle, >> right? Similarly stressful situation.

[00:29:50]>> So, do your findings uh support the diagnosis of a traumatic brain injury?

[00:29:56]>> Uh, yes, they do. And I'm going to talk a little bit about the uh helps tool. Um what what does that measure particularly?

[00:30:05]>> So it's a list of things that are commonly found in people with traumatic brain injuries. Uh as I cited some of them earlier, some of them are physical symptoms like headaches. Um some of them are you know inability or poor ability to do things like reading or calculating. Um some of them are related to emotional functioning like anxiety and depression. But essentially, it's a very long list of things that they've found are very common in people who have what we call TBI for short or traumatic brain injuries.

[00:30:36]>> Sure. And I I'm just going to list through the uh the symptoms that Miss Dyman um identified that you noted here.

[00:30:41]So, >> um headaches.

[00:30:43]>> Yes.

[00:30:44]>> And that's pretty common as you explained.

[00:30:46]>> Yes, it is.

[00:30:47]>> Anxiety?

[00:30:48]>> Yes.

[00:30:49]>> Depression?

[00:30:50]>> Yes.

[00:30:51]>> Difficulty concentrating?

[00:30:52]>> Yes.

[00:30:53]>> Difficulty with memory?

[00:30:54]>> Yes.

[00:30:55]>> Trouble reading? Yes.

[00:30:58]>> Trouble calculating?

[00:30:59]>> Yes.

[00:31:00]>> Or problem solving abilities?

[00:31:03]>> Yes.

[00:31:04]>> Difficulty performing tasks in a job?

[00:31:06]>> Yes.

[00:31:07]>> Difficulty with judgment?

[00:31:09]>> Yes.

[00:31:09]>> And these were all um symptoms that were identified with respect to Miss Dykeman in the helps survey.

[00:31:15]>> Right.

[00:31:16]Now, um, did her responses to any of your question on any of the assessments, um, corroborate the, uh, expressive language difficulties?

[00:31:27]>> Yes. As I stated, just in interviewing her as, as well as on numerous other tests, she had difficulty expressing herself. she would become visibly frustrated when she was trying to make a point and it just she couldn't find the right words to say it or she would get things confused or in the wrong order and it wasn't making sense. Um and and I think at some point she even commented on that that people commonly don't understand her correctly or they don't understand her the same I think she said.

[00:31:56]>> Sure. And are the uh um based on your observations, was Miss Dykeman's responses and her appearance consistent with somebody who's suffering from a traumatic brain injury?

[00:32:06]>> I believe so. Yes.

[00:32:08]>> Now, that was one of the things that you mentioned, right, was that uh um her fear that uh people were not understanding how she was or what she was trying to convey. Is that common for uh patients with traumatic brain injuries?

[00:32:22]>> Yes. They become very frustrated because it's a change in functioning. Suddenly, they're trying to tell someone something and it's not coming out right. They can't come up with the words. They're using the wrong words. They can't tell a coherent story anymore. So, they become very frustrated. Um, a lot of times people just sort of stop communicating um and and sort of give up on it when it's not working. But, it's it's very common for people to be frustrated with that.

[00:32:48]>> What are some of the uh um common reactions for somebody with those deficits? uh if they're they're experiencing frustration uh and and an inability to communicate.

[00:32:58]>> Well, as I said, they may just sort of give up and say, you know, they're they're not getting it. I'm not going to try anymore. They just become very frustrated.

[00:33:05]>> Did you observe that reaction with Miss Dykeman at all?

[00:33:08]>> Yes.

[00:33:09]>> So, let's talk about post-traumatic stress disorder. Um you you made a diagnosis of PTSD with dissociative features. Is that right?

[00:33:17]>> Correct.

[00:33:18]>> What generally is post-traumatic stress disorder? Uh so a person has to have experienced witnessed or experienced um a either something that was life-threatening um or a sexual assault um but essentially something where they they feared for their life or or their um you know basically well a threat. I'm sorry I missed one. So they can also hear about the the death or the threatened death of a close loved one.

[00:33:47]So, it's th those three things. They either were the victim of, witnessed to, or heard of a close uh family member or friend being seriously injured or sexually assaulted.

[00:33:57]>> And we we often hear about this label with uh um the brave service members who uh come back from combat zones. Um am I correct in assuming that this is not a diagnosis that's limited just to our service members?

[00:34:10]>> No, it's not. I mean, you have to have experienced the trauma, but then there's a whole uh host of symptoms. There's four different clusters, different types of symptoms that a person has to exhibit to then be diagnosed with post-traumatic stress disorder. So there are people out there that go through very traumatic things and just recover well. They don't develop those symptoms. So just having gone through the trauma doesn't mean you'll be diagnosed with it. You have to manifest the symptoms as well.

[00:34:36]>> Is it important in making this diagnosis to consider the patient's history of traumatic experiences that she's had?

[00:34:42]>> Yes. And uh did you do so in the case of Miss Dykeman?

[00:34:45]>> I did.

[00:34:46]>> Generally speaking, what was important about her description of prior trauma to making this diagnosis?

[00:34:52]>> Uh well, she had reported uh a history of being sexually assaulted, physically assaulted on multiple occasions. Uh she'd had two traumatic uh brain injuries also from uh an assault. So those things all count as as traumatic events.

[00:35:08]>> Okay. And is that the type of uh information that psychologists commonly consider when making a diagnosis of PTSD?

[00:35:14]>> Yes.

[00:35:16]>> So, um did you conduct any uh testing or other instruments to determine whether or not Miss Dyman's symptoms are consistent with PTSD?

[00:35:24]>> I did.

[00:35:25]>> Um what assessment in particular?

[00:35:28]>> Uh well, I did a general personality inventory. It's called the the personality assessment inventory. Uh and so that would among other things it would pick up something like uh trauma symptoms. Then I also gave her a trauma specific measure because I'd been informed that that might be an issue. Uh I gave her the the DAPS or the detailed assessment of post-traumatic stress. Uh and then I also ultimately administered a a dissociation inventory. Think it's the multi-cale dissociation inventory.

[00:35:58]>> Let's start with the DAPs. What what does the DAPS actually measure? So, it's looking at we there's actually now four symptom clusters that they've identified for post-traumatic stress disorder. That one actually only looks at three because at the time the instrument was made. We didn't really understand the fourth one, but it looks at three of the major symptom clusters uh for PTSD which are reexperiencing things like nightmares, flashbacks, intrusive memories, um avoidance behaviors and then um the uh hyperarousal, hyper hypervigilance c type of symptoms.

[00:36:33]>> Okay, let's start at the top. Uh what is reexperiencing?

[00:36:36]Uh, so most often people think of flashbacks, although that's probably one of the less common ones. More common are nightmares and just intrusive memories.

[00:36:44]People thinking back on the event without wanting to and those things interfering in their their functioning.

[00:36:50]Um, nightmares, they're not even always about the traumatic event. They can be about other things, but it's those chronic nightmares and sleep disruption that happens.

[00:36:59]>> Okay. And uh, did you find that Miss Dykeman um, meets this symptom cluster for reexperiencing?

[00:37:04]>> She did. In what ways?

[00:37:06]>> So, she had uh frequent nightmares. Uh she reported that it was often of being beaten by uh her partner. Um she also reported having uh memories happen when she didn't want them to, things triggering them. Uh so loud noises and she she'd have a a memory of one of those events.

[00:37:26]>> How about being yelled at? Was that something that she described?

[00:37:29]>> Right. being yelled at, any sort of loud noises, but particularly yes, human voices, yelling was was one in particular.

[00:37:36]>> All right. So, what is avoidance?

[00:37:38]>> Avoidance um can be in two forms. One can be sort of mental. So, people using drugs or alcohol to try to mentally escape from thinking about the trauma.

[00:37:47]Um it can also be physical separation.

[00:37:49]So, um sometimes you those are things that are reminiscent of the trauma. be a particular type of person or a place or a smell. Um things that they avoid that somehow remind their brain of the trauma, but it's um and a lot of times it's just people don't want to talk about it. That's why getting people into therapy for it is is so difficult because people are trying to avoid thinking about it.

[00:38:13]>> Um did you find that Miss Dykeman experienced avoidance?

[00:38:17]>> She did. Um she didn't want to Oh, sorry. she did not want to uh discuss a lot of the details of it. Um she uh it's a little difficult when she was in uh a relationship that was abusive because then it's a little bit more difficult to avoid those things.

[00:38:36]People then tend to sort of mentally check out. Um but there were things that she said she would avoid. Um like semi-truckss, loud stores, and again that would be the loud sudden noise that jolts people that jolted her in particular. Um, and finally, what is hyperarousal?

[00:38:54]>> Hyperarousal can be um anything from what I I think is commonly known uh as hypervigilance. So, uh sort of being on high alert all of the time. Um it also is being highly reactive, overreactive to things that normally a person wouldn't react to, but their brain is is reacting to it when they have PTSD. Um, it can be a constant sense of agitation or anger or just that that high um your nervous system is on high alert all of the time essentially.

[00:39:28]>> Okay. Um, and did you find that Miss Dykeman experienced hyperarousal?

[00:39:33]>> She did. Oh. Uh, easily startled is another symptom of that, but yes, she was very hypervigilant all of the time.

[00:39:39]Felt very, uh, anxious and on edge.

[00:39:42]>> Okay. Um, what is the fourth symptom cluster? Uh so that's a negative alteration in mood and cognition. So that can be um chronic depression, chronic anxiety, inappropriate outbursts of of anger and irritability, um impulsivity, uh reckless uh reckless behavior that has the potential for uh you know sort of self-destructive types of things.

[00:40:07]>> Did you find that Miss Dykeman described symptoms consistent with that fourth symptom cluster?

[00:40:12]>> I did. She had depression. She had anxiety. Um, but she also had the the sort of again that flat a effect that I mentioned earlier, that emotional restriction. That's also common. It's sort of a desensitization. So instead of overreacting, the person underreacts because that's their that's the the manifestation of that altered cognition and mood for them.

[00:40:34]>> Yeah. Why don't you tell us what flat a effect looks like in practice?

[00:40:38]>> So it looks like a person maybe is very detached. They don't care. They're not reacting. you don't see any visible um facial expressions changing. Um you know, usually people when something provocative is going on, people react.

[00:40:53]You'll hear it in their voice. You'll see it on their face. Well, pe when people have flat affect none of that is there. And it can be for a variety of reasons.

[00:41:02]>> Um is that a defense mechanism for patients?

[00:41:06]>> It it can be. Yes, that can be one of the reasons that you see that is it's sort of a way it's it's a coping way because when people are overwhelmed by trauma and negative things, that's a way they can detach from it is just by not reacting to it and sort of mentally separating from the the dangerous environment.

[00:41:24]>> Doctor, if uh somebody is displaying that flat a effect um and not reacting, does that necessarily mean that they're not experiencing emotions?

[00:41:32]>> No, it doesn't.

[00:41:34]Um, can that symptom be misinterpreted by others?

[00:41:38]>> It it can. I've seen that happen a lot.

[00:41:39]Yes.

[00:41:43]>> Let's talk about dissociative symptoms.

[00:41:46]What does that mean?

[00:41:48]>> Uh, essentially a mental separation from the environment. So again, it's a coping mechanism. When people are exposed to trauma, they they get overwhelmed experiencing that and so mentally their brain sort of separates from it. And a lot of times that comes with memory gaps because they're they're mentally not there. Somebody watching someone who's dissociating, they may just sort of look like they're spacing out and they're not really in that moment. Um or they may not. Um but essentially the the mind is is not in that moment. It's separated from the the situation.

[00:42:22]>> Why do patients with PTSD sometimes experience dissociative symptoms?

[00:42:26]>> To to cope. It's an being overwhelmed.

[00:42:29]the stimulus around whatever is going on is too overwhelming. They can't stay in it and so that's a way um that they try to separate from it.

[00:42:37]>> Did you observe any uh symptoms with regard to Miss Dykeman that were consistent with dissociation?

[00:42:43]>> I I did. So, she not only described in describing some things, excuse me, um described what sounded like dissociative episodes, but when I was talking with her about specific topics, she seemed to possibly be dissociating at times where she would just sort of stop and not be responding and then get stuck and not remember what I had said to her. So, sort of missing part of the conversation. You'll notice that in people who dissociate is they stop tracking. and they just sort of look like they're zoned out. They're not engaged in the here and now anymore.

[00:43:20]>> Um, is there an instrument that you use to um rate the symptoms of dissociative symptoms?

[00:43:27]>> I did I used the the multi-scale um dissociation inventory.

[00:43:33]>> What is that measure?

[00:43:34]>> Um, a few different things. So, it looks at um emotional restriction. It looks at um mental separation from the environment. It looks at uh memory gaps.

[00:43:46]I think depression. There's a few other scales.

[00:43:49]>> Sure. Um let let's start with separation from the environment. What does that mean?

[00:43:54]>> So, as I was describing, it's where the person mentally, you know, has to detach in order to cope with the environment.

[00:44:00]>> And uh did you um find those symptoms in Miss Dykeman with the multi-cale dissociation inventory?

[00:44:08]>> Right. According to the inventory, she had very high levels of of mental separation.

[00:44:14]>> All right. What's what does it mean when you say a high level of emotional restriction?

[00:44:18]>> Uh so that would be that flat a effect I was describing earlier.

[00:44:22]>> Okay. And did the uh MDI also uh support the finding that Miss Dyman had a high level of emotional restriction?

[00:44:29]>> It did.

[00:44:31]>> And let's talk about significant memory disturbances. Um can you tell us what that means in the context of this instrument?

[00:44:39]>> Uh so just not being able to remember portions of events. Um the person when the when the mind separates in a dissociation, it doesn't encode memories in the same way. I mean they've looked at this in neurological uh scans, lots of research, the brain actually doesn't encode the memories the same. So um it's not that they're not in there. Sometimes they are and they can be retrieved in ways later on, but they're just they don't go into the brain in the in the correct way that you can just pluck it out and say, "Oh, I remember that." Um, so because of that, when a person goes through an experience, they may be missing pieces of that and not be able to correctly recall them.

[00:45:17]>> Okay. Did you find any uh um was Miss Dykeman's MDI results consistent with significant memory disturbances?

[00:45:24]>> It did. That that scale was also elevated. Yes. My understanding is that uh several of the other categories Miss Dykeman did not meet um in the MDI for dissociative symptoms. Is that correct?

[00:45:35]>> Correct.

[00:45:36]>> Okay. Um let's talk about malingering.

[00:45:39]You said what malering was, but do you have built-in measures to test for malingering when you're doing these instruments?

[00:45:46]>> Yes. So, there's uh a few different ways. There are instruments that specifically look for malingerine.

[00:45:52]That's what they're created for. Uh there are also often uh validity uh scales within tests uh to look for things like over reporting of symptoms or under reporting or inconsistent reporting. So those are also um things that can give you ideas about malingering. Sometimes it's just looking at the consistency of responses and I can maybe talk more about that later but those so there's everything from very specific formal measures to measures within more general measures and then just behavioral observations. do we know to look for?

[00:46:24]>> So, it's built into the instruments themselves. Um, some of these are questions that you can look to for inconsistent or unreliable responses, >> right?

[00:46:32]>> Um, any indication that Mr. Ms. Dykeman was mingering or exaggerating her symptoms, as you've discussed?

[00:46:40]>> No. And and as I stated in the in the very beginning, she she actually minimized a lot of her symptoms. She didn't exaggerate them. She really wasn't trying to uh you know say that they were very strong for her. They would still come up in the instruments, but she she minimized them essentially.

[00:46:57]>> Why is that clinically significant?

[00:47:00]>> Well, actually what we find is people who have genuine mental illness, that's typically what they do. It's not the people saying, "Hey, I'm really sick.

[00:47:06]I'm really ill. This is what's going on." It's often the people who are saying, "I I don't I don't think I have an illness. You know, I don't think this is wrong with me." They don't want to talk about or acknowledge the symptoms.

[00:47:17]So, uh, that that's pretty common.

[00:47:19]>> Fair to say that a lot of people don't want to acknowledge that they have something wrong with them, >> right?

[00:47:25]>> All right. Is it important uh in examining malingering to review prior um neuroscychological testing or records?

[00:47:34]>> Uh, yes, if they're available, that can be helpful.

[00:47:37]>> Why is that important?

[00:47:40]>> So, it you're looking at patterns over time. How long have whatever these reported symptoms are been present? If it's a legal case, it can be very significant because if you have records from before the person was was accused of something, that's significant because then if you're only seeing it after the fact, they had no symptoms before, wasn't reporting anything, they get accused of something, suddenly they have this whole host of symptoms, that's a little bit more suspicious. Whereas if they were reporting these symptoms long before, not in the context of a legal evaluation, that that's a lot more um that's a solid piece of evidence that that's been there for a longer period of time, that there's no motivation to be creating fake symptoms.

[00:48:23]>> Um in the course of trying to evaluate uh Miss Dykeman's condition and whether or not she was malingering, did you uh review a uh progress note by Dr. Raymond list, a neurosychologist?

[00:48:35]>> I did. Yes.

[00:48:37]>> And uh >> take a look at that.

[00:48:50]>> This looks to be it. Yes.

[00:48:52]>> Okay. And uh um what about Dr. List's evaluation of Miss Dykeman in 2021 was important to your findings here?

[00:49:00]>> Uh he noted several of the same things.

[00:49:02]I believe he gave her a diagnosis of PTSD. Um yes he did. He also said mild cognitive disorders. The diagnostic impressions were similar. She was he found some of the very same things I did. The significant memory deficits uh with uh memory attention all of those kinds of things. He gave the RB bands which meant to be something you can repeat over time, hence the name. So he gave one of the same instruments I did um found similar similar results significant deficits with um uh with language and with memory. So just very consistent with my findings and this was I believe 2021. So you know and I did my evaluation in 2023. So yeah, several years earlier and and before uh the the criminal uh allegations.

[00:49:51]>> Would you expect that consistency in somebody who's not mingering?

[00:49:56]>> Somebody who's not mingering? Yes. Well, yes. I would expect consistency in someone who's not malingering. Correct.

[00:50:01]>> My apologies. That was a poor question.

[00:50:03]>> Too many negatives there. Yeah.

[00:50:05]>> Offer 275.

[00:50:07]>> Any objection?

[00:50:09]>> Just what was already put on the record, your honor.

[00:50:11]>> Okay. Received.

[00:50:13]>> All right. So, um, just generally speaking, were you able to come to any conclusions about whether Miss Dykeman's emotional presentation um could be misinterpreted by others?

[00:50:27]>> It often is. People have an expectation of how other people should look or react in certain situations. And particularly when there's uh a mental illness involved or cognitive deficiencies involved, you may not see what you expect, but that doesn't mean that a person isn't feeling uh emotions. Uh that may be, as I discussed earlier, a coping or a defense mechanism.

[00:50:51]Um what are some common triggers for uh um PTSD or episodes related to PTSD that could trigger some of those symptoms?

[00:51:00]>> Um things that are reminiscent to that person for the the initial traumas and that's different for everyone, but loud noises is uh is a frequent one. Loud noises, loud um bright lights, being overwhelmed by um a lot of people. um then it sort of gets more those are sort of the more common general ones being more specific. It just sort of depends on the trauma. So maybe um a certain smell or certain type of person if they were abused by a very overbearing um you know type of person maybe they had a beard then everyone with beards they may be on edge things like that.

[00:51:34]>> Sure. Um if a person with Miss Dykeman's deficits struggles with memory is that necessarily a sign that she's lying?

[00:51:44]No.

[00:51:46]>> Um, and if a person with Miss Dykeman's deficits um struggles to display ordinary or normal emotion, is that necessarily a sign that she's lying?

[00:51:56]>> No.

[00:51:57]>> Um, so doctor, you you have experience uh um evaluating patients who have been survivors of domestic abuse?

[00:52:09]>> Yes.

[00:52:10]And uh are you familiar generally with the emotional and social aspects of domestic violence that help to perpetuate the cycle of abuse?

[00:52:18]>> Yes.

[00:52:19]>> Could you explain the dynamics just briefly to the jury >> of the >> of physically violent relationships?

[00:52:25]>> Sure. Um well both physically when there's physical violence there's also some degree of emotional and psychological violence and that can be a little bit trickier um to for people to identify as abuse. A lot of times the the victim feels like it's normal. It's not as bad as it seems because of that aspect of of psychological abuse in there as well.

[00:52:47]There's usually elements of control where um you know the person may be cut off from friends and family, the um the person controls the money, those kinds of things. They may convince them that they're not good enough um to do other things. But essentially, it's a cycle where it's not always bad. You know, they have periods. We often call it the honeymoon phase where people they're getting along great and things seem to be just wonderful and then sort of the tension builds up and there's, you know, some some physical abuse or or what have you and then it it starts over. They reconcile. But essentially the the victim comes to believe that either a it's it's normal or it's some somewhat justified and and two that it's not something that they can easily escape.

[00:53:30]There's all of these different components to the abuse that they come to believe that's just something they're they're in.

[00:53:37]>> Do survivors of abuse have difficulty leaving their abusers?

[00:53:41]>> Yes, very often. You I don't remember this statistic anymore. I think it might be like seven or eight times is usually the number of attempts that people make before they can successfully leave an abusive relationship. So, it's common that they have difficulty.

[00:53:56]>> Why is that?

[00:53:57]because of all of those elements of um control and sort of uh coercion and manipulation, a person um some things that are typical of if if people have kids, they'll say, "Well, I'm going to make sure you never see your kids again." Or they will cut off the relationships a person has with um supportive people like family, friends.

[00:54:20]Um, I've actually even seen people physically, you know, put cars in the driveway so the person couldn't leave or take the person's car keys. Um, they may control all of the money. They may do a lot of the emotional um, abuse where they're telling the person, "You're not good enough. Nobody else would ever want you. You're not smart enough." Those kinds of things.

[00:54:40]>> Is it common for survivors of abuse to protect their abusers?

[00:54:44]>> Oh, yeah. Yeah.

[00:54:46]>> For all the same reasons.

[00:54:47]>> Correct. Is it common for people in abusive relationships to view it as their normal?

[00:54:53]>> It is. It is. It becomes their normal.

[00:54:55]Absolutely.

[00:54:56]>> Um, now you you mentioned just briefly some of the factors of uh abuse, but am I correct in assuming that domestic abuse doesn't just include physical abuse?

[00:55:06]>> No. Typically, you will also see the emotional component. And like I said, that can be much more confusing for people because wherein, you know, if if they have a broken arm, they can say, "Well, yes, he broke my arm." But there's so much manipulation and psychological um aspects to the other forms of abuse that those are sometimes worse.

[00:55:26]>> Um seems like an obvious question and it is, but how about sexual assault? Is that a form of domestic abuse?

[00:55:32]>> Yes.

[00:55:33]>> Um do survivors of abuse ever feel guilt over their abuser circumstances um when they're arrested or accused of a crime for their abuse?

[00:55:42]>> Yes, it really is a mind game. I mean the I' I've seen so many victims just protect and lie for uh their abusers. I I evaluated a woman who had been in multiple abusive relationships which once she was out of them she could see they were abusive but when she was in the one that she was in and he was doing the exact same things she couldn't see it as abusive because it's just it's it it's very confusing for them the mind games and the manipulation that occurs.

[00:56:11]Is are all these uh reasons why survivors have trouble reporting abuse to the authorities?

[00:56:17]>> Yes.

[00:56:20]>> Is there anything in particular about Ms. Dykeman's uh cognitive conditions that would be a an additional barrier to her leaving an abusive relationship?

[00:56:29]>> Sure. So, she's not functioning at 100% either, you know, emotionally or cognitively. And so, that would make it more difficult for someone like her to leave an abusive relationship. um she doesn't, you know, she can't function as independently as someone without those deficits and emotionally she's constantly struggling. And so all of those things are just going to be amplified and and making it difficult to leave.

[00:56:53]>> Is Miss Dykeman's uh um PTSD symptomology consistent with somebody who's been domestically abused?

[00:57:00]>> Yes, I believe so.

[00:57:02]>> So, Dr. um are all the opinions that you've offered here today to a reasonable degree of professional certainty?

[00:57:08]>> Yes.

[00:57:09]And uh um I would offer um her report if I haven't done that at this point.

[00:57:17]>> I believe I have.

[00:57:18]>> I think it's already been received. It will be re I think it was already received. That's all the questions I have. Thank you.