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The present meta-analysis provides the first meta-analysis of research on stand-alone neurocognitive feigning tests since publication of the preceding paper by Vickery, Berry, Inman, Harris & Orey (2001). Studies of dedicated neurocognitive feigning test performances in adults appearing in published or unpublished (theses and dissertations) sources through October 2010 were reviewed and subjected to stringent inclusion criteria to maximize the validity of results. Neurocognitive feigning tests were included only if at least three contrasts of criterion-supported honest patient groups and feigners were available. Tests that met criteria for review included the Victoria Symptom Validity Test, used as an anchor to compare Vickery and colleagues' results; Test of Memory Malingering, Word Memory Test, Letter Memory Test, and Medical Symptom Validity Test. Effect sizes and test parameters at published cut scores were compiled and compared. Results reflected large effect sizes for all measures (mean d = 1.55, 95% confidence interval [CI] = 1.48-1.63). Mean specificity was 0.90 (95% CI = 0.85-0.94). Mean sensitivity was 0.69 (95% CI = 0.63-0.75). Several moderators of effect size were identified, with certain manipulations resulting in a weakening of effect size. Unexpectedly, warning simulators to feign believably increased effect sizes.

The current study examined the effectiveness of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath and Tellegen, 2008) over-reporting indicators in civil forensic settings. The MMPI-2-RF includes three revised MMPI-2 over-reporting validity scales and a new scale to detect over-reported somatic complaints. Participants dissimulated medical and neuropsychological complaints in two simulation samples, and a known-groups sample used symptom validity tests as a response bias criterion. Results indicated large effect sizes for the MMPI-2-RF validity scales, including a Cohen's d of .90 for Fs in a head injury simulation sample, 2.31 for FBS-r, 2.01 for F-r, and 1.97 for Fs in a medical simulation sample, and 1.45 for FBS-r and 1.30 for F-r in identifying poor effort on SVTs. Classification results indicated good sensitivity and specificity for the scales across the samples. This study indicates that the MMPI-2-RF over-reporting validity scales are effective at detecting symptom over-reporting in civil forensic settings.

MMPI-2 results from 39 moderately to severely head injured (HI) and 44 community volunteer (CV) participants given instructions to feign symptoms or answer honestly during an analog forensic neuropsychological examination were compared. No significant effects for HI or the interaction between the HI and instruction set (IS) factors were noted on either clinical or selected validity scales (F, Fb, F(p), Ds2, FBS). However, the main effect of IS was significant for both clinical and validity scales (median Cohen’s d=1.34 and 1.39, respectively). Most validity scales were characterized by perfect specificity rates but low to modest sensitivity, whereas FBS had both moderate sensitivity and specificity. Logistic regressions showed that the F and Ds2 scales made a significant contribution independent of motivational tests to the identification of feigning during neuropsychological examination.

This study investigated the possibility that head-injured patients, by virtue of their exposure to medical and legal evaluations, are better able to feign deficits than controls. Both internal and external validity issues were addressed in a malingering simulation using 46 moderately to severely head injured and 46 matched control subjects who were administered a battery of neuropsychological and motivational tests under standard or malingering instructions. Results showed no significant interaction between malingering instructions and head injury status on commonly used motivational tests or neuropsychological tests, nor were the head injured malingerers better able to avoid detection using established cutting scores on motivational tests. These results suggest that head injured individuals are no more able to feign neuropsychological deficits successfully than non-head injured individuals.

Few studies to date have cross-validated indicators of malingering that have been suggested on various neuropsychological tests. This study presents data cross-validating several indicators of malingering on neuropsychological tests, as well as on tests of malingering and via behavioral observations. It incorporates methodological recommendations by Rogers [Researching dissimulation. In: R. Rogers (Ed.), Clinical assessment of malingering and deception (pp. 309-327). New York: Guilford Press.] resulting in an ecologically valid design utilizing college students with a history of mild head injury as analog malingerers. Results indicated that the Letter Memory Test (LMT) and the Digit Memory Test (DMT) attained the highest hit rates for the detection of malingering, while the sensitivity of many other measures declined on cross-validation.

Thirty-two studies of commonly researched neuropsychological malingering tests were meta-analytically reviewed to evaluate their effectiveness in discriminating between honest responders and dissimulators. Overall, studies using the Digit Memory Test (DMT), Portland Digit Recognition Test (PDRT), 15-Item Test, 21-Item Test, and the Dot Counting Test had average effect sizes indicating that dissimulators obtain scores that are approximately 1.1 standard deviations below those of honest responders. The DMT separated the means of groups of honest and dissimulating responders by approximately 2 standard deviations, whereas the 21-Item Test and the PDRT separated the groups by nearly 1.5 and 1.25 standard deviations, respectively. The 15-Item Test and the Dot Counting Test were less effective, separating group means by approximately 3/4 of a standard deviation. Although the DMT, PDRT, 15-, and 21-Item Tests all demonstrated very high specificity rates, at the level of individual classification, the DMT had the highest sensitivity and overall hit-rate parameters. The PDRT and 15-Item Test demonstrated moderate sensitivity, whereas the 21-Item Test demonstrated poor sensitivity. The less than perfect sensitivities of all the measures included in this review argue against their use in isolation as malingering screening devices.

Recently, much research has focused on the development and utilization of various motivational assessment techniques designed to identify malingered neuropsychological test performance. Other findings have suggested a strong link between the motivation of the subject and the degree to which the neuropsychological test results validly represent the individual's true level of functioning. However, the majority of the empirical work in this area has focused on only one end of the motivational spectrum, decreased motivation. In order to obtain a more complete assessment of the relationship between motivation and neuropsychological of test results, the present study involved an evaluation of the effects of motivational differences on test performance across three levels of motivation: high, low, and standard in 75 head-injured college students. Results supported past research showing significant decreases in test performance by participants given individual financial incentives ($25.00) to perform poorly. Additionally, the sensitivity of several malingering tests to this response set was supported. However, no reliable differences were found on neuropsychological or motivational tests between the group given financial incentives ($25.00) to perform well and the standard instruction group.

Scores on the New Adult Reading Test-Revised (NART-R) were used to estimate WA1S-R IQ scores obtained approximately 3.5 years earlier from 54 normal older persons (M = 68 y; SD = 8.6). NART-R estimated IQ scores correlated reliably with earlier obtained IQ scores: FS1Q r = 0.70; VIQ r = 0.68; PIQ r = 0.61 (all p's < 0.05). NART-R estimated FSIQs underpredicted obtained FSIQs by an average of 3.8 points (SD = 9.3). The correlation between estimated and obtained FSIQ is fairly high and estimated FSIQ is reasonably close to obtained IQ, despite the considerable length of time passing between WAIS-R and NART-R administration. These results represent the first confirmation of the retrospective accuracy of the NART-R in estimating WAIS-R scores across time, a previously untested but critical assumption for clinical application of this approach. These results also apparently represent the first cross-validation of the NART-R in a sample of older Americans. These results suggest that further research on the clinical utility of the NART-R is warranted.

We compared 8 patients diagnosed with geriatric sleep apnea syndrome (GSAS) with 12 healthy older controls (GCON) matched on age, sex, weight, education, and socioeconomic standing. GSAS was diagnosed if patients had an apnea + hypopnea index (AHI) greater than or equal to 10 and an impairment involving at least two of the following: hypertension, cardiac arrhythmias, or daytime hypersomnolence. In addition to significant differences on selection variables (e.g., AHI, frequency of hypertension, Multiple Sleep Latency Test), GSAS patients had significantly more sleep disturbance, were sleepier on subjective measures, were more depressed, and had lower scores on tests of nonverbal problem solving and nonverbal memory. Thus, GSAS resembles SAS described in middle-aged populations. More research is needed to determine the most efficient diagnostic parameters for identifying pathological levels of SDB in older persons.

Sleep problems in the healthy elderly were studied in 628 community-dwelling older adults. Self-report of daytime sleepiness in this group was evaluated. Self-reported snoring was significantly associated with reports of daytime sleepiness (p < 0.001), and reported health showed significant associations with age group (p < 0.001), reports of breathing problems (p < 0.001), and reports of excessive daytime sleepiness (p < 0.01). The data strongly support the impact of sleep-related factors on self-perceptions of health in community dwelling older adults. Even as a subjective self-report measure, snoring readily predicts self-reported problems with daytime sleepiness.

We studied the waking medical, sleep, and psychological status of 28 healthy older persons who had undergone nocturnal polysomnography and daytime assessment approximately 1-year earlier. In a previous report based on this sample, we found that sleep-disordered breathing (SDB) indices were not related to concurrent measurements of daytime functioning. However, in the present study, we observed relationships between the original SDB indices and several measures of cardiopulmonary functioning obtained 1 year later. At follow-up, subjects with originally high levels of SDB had significantly higher systolic blood pressure and poorer pulmonary function test results, were more likely to report irregular heartbeats in the previous year, and had experienced more disruptive snoring than the remaining subjects. When combined with other recent data, these results raise the possibility that SDB exerts an insidious pathological influence on the health and daytime functioning of otherwise healthy older persons.