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Objective: Some attorneys claim that to adequately cross examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. The objective of this paper is to critically examine whether direct access to protected test materials by attorneys is indeed necessary, appropriate, and useful to the trier-of-fact. Method: Examples are provided of the types of nonscientific misinformation that occur when attorneys, who lack adequate training in testing, attempt to independently interpret neurocognitive/psychological test data. Results: Release of protected test information to attorneys introduces inaccurate information to the trier of fact, and jeopardizes future use of tests because non-psychologists are not ethically bound to protect test content. Conclusion: The public policy underlying the right of attorneys to seek possibly relevant documents should not outweigh the damage to tests and resultant misinformation that arise when protected test information is released directly to attorneys. The solution recommended by neuropsychological/psychological organizations and test publishers is to have protected psychological test information exchanged directly and only between clinical psychologist/neuropsychologist experts. [ABSTRACT FROM AUTHOR]

Objective:This review provides a summary of historical details and current practice activities related to Forensic Neuropsychology (FN). Under the auspices of the American Board of Clinical Neuropsychology (ABCN), the Forensic Neuropsychology Special Interest Group (FNSIG) views the FN as a subspecialty, which has developed over time as the straightforward result of more than 20 years of numerous publications, extensive continuing education, focused research and growth of forensic practice within neuropsychology. In this article, the FNSIG core work group documents and integrates information that is the basis of efforts to consolidate practice knowledge and facilitate attainment of forensic practice competencies by clinical neuropsychologists. Method:Overview of continuing education topics at professional conferences, search results that identify relevant books and peer-reviewed publications, as well as pertinent findings across years of large-scale national survey results. Results:Relevant evidence has shown for decades that FN is prominent within Clinical Neuropsychology as practiced in the United States and Canada. A majority of U.S. neuropsychologists have received FN training and provide forensic evaluation services. FN practice time per week is considerable for many practitioners, and across survey epochs has been shown to be increasing. Conclusion:The present review leads to the conclusion that in the interest of promoting the acquisition of competence, FN practice should remain a focal point of training and continuing education. Alternate routes to attain competence are discussed, as are ongoing professional activities that undoubtedly will ensure continued growth of, and interest in, the subspecialty of FN. [ABSTRACT FROM AUTHOR]

To cross-validate RAVLT performance validity cut-offs and the RAVLT/RO discriminant function in a large neuropsychological sample. RAVLT scores and the RAVLT/RO discriminant function were compared in credible (n = 100) and noncredible (n = 353) neuropsychology referrals. Noncredible patients scored lower than credible patients on RAVLT scores and the RAVLT/RO discriminant function. With cut-offs set to ≥90% specificity, highest sensitivities were observed for the discriminant function (cut-off ≤.064; 55.8%), recognition total (cut-off ≤9; 53.1%), the recognition combination score (≤10; 47.7%), and total learning across trials (cut-off ≤31; 45.3%). Individuals with histories of learning difficulties were over-represented in the 10% of credible patients exceeding cut-offs. When these individuals were removed, cut-offs could be tightened while still maintaining at least 90% specificity, and thereby increasing sensitivity (e.g., recognition total cut-off ≤10, 65% sensitivity; RAVLT/RO discriminant function cut-off ≤.176, 58% sensitivity). When three of the most sensitive, non-overlapping scores were considered in combination, 17% of credible patients failed ≥1 of the three cut-offs, while 3% failed two, and only 1% failed all three. In contrast, in the noncredible sample, more than two-thirds failed one or more of the three cut-offs, nearly half failed ≥2, and nearly a quarter failed all three. RAVLT PVT cut-offs and the RAVLT/RO discriminant function achieve approximately 50% sensitivity, and approach 65% sensitivity when cut-offs specific to samples without histories of learning problems are employed, confirming that RAVLT cut-offs and the RAVLT/RO discriminant function continue to be valuable techniques in the identification of performance invalidity. [ABSTRACT FROM AUTHOR]

To provide education regarding the critical importance of test security for neuropsychological and psychological tests, and to establish recommendations for best practices for maintaining test security in forensic, clinical, teaching, and research settings. Previous test security guidelines were not adequately specified. Neuropsychologists practicing in a broad range of settings collaborated to develop detailed and specific guidance regarding test security to best ensure continued viability of neuropsychological and psychological tests. Implications of failing to maintain test security for both the practice of neuropsychology and for society at large were identified. Types of test data that can be safely disclosed to nonpsychologists are described. Specific procedures can be followed that will minimize risk of invalidating future use of neuropsychological and psychological measures. Clinical neuropsychologists must commit to protecting sensitive neuropsychological and psychological test information from exposure to nonpsychologists, and now have specific recommendations that will guide that endeavor. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to compare performance on a wide range of PVTs in a neuropsychology clinic sample of African Americans and White Americans to determine if there are differences in mean scores or cut-off failure rates between the two groups, and to identify factors that may account for false positive PVT results in African American patients. African American and White American non-compensation-seeking neuropsychology clinic patients were compared on a wide range of standalone and embedded PVTs: Dot Counting Test, b Test, Warrington Recognition Memory Test, Rey 15-item plus recognition, Rey Word Recognition Test, Digit Span (ACSS, RDS, 3-digit time, 4-digit time), WAIS-III Picture Completion (Most discrepant index), WAIS-III Digit Symbol/Coding (recognition equation), Rey Auditory Verbal Learning Test, Rey Complex figure, WMS-III Logical Memory, Comalli Stroop Test, Trails A, and Wisconsin Card Sorting Test. When groups were equated for age and education, African Americans obtained mean performances significantly worse than White Americans on only four of 25 PVT scores across the 14 different measures (Stroop Word Reading and Color Naming, Trails A, Digit Span 3-digit time); however, FSIQ was also significantly higher in White American patients. When subjects with borderline IQ (FSIQ = 70 to 79) were excluded (resulting in 74 White Americans and 25 African Americans), groups no longer differed in IQ and only continued to differ on a single PVT cutoff (Trails A). Further, specificity rates in African Americans were comparable to those of White Americans with the exception of the b Test, the Dot Counting Test, and Stroop B. PVT performance generally does not differ as a function of Black versus White race once the impact of intellectual level is controlled, and most PVT cutoffs appear appropriate for use in African Americans of low average IQ or higher. [ABSTRACT FROM AUTHOR]

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term 'malingering.' Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures. [ABSTRACT FROM AUTHOR]

Objective: To cross-validate the Dot Counting Test in a large neuropsychological sample. Method: Dot Counting Test scores were compared in credible (n = 142) and non-credible (n = 335) neuropsychology referrals. Results: Non-credible patients scored significantly higher than credible patients on all Dot Counting Test scores. While the original E-score cut-off of ≥17 achieved excellent specificity (96.5%), it was associated with mediocre sensitivity (52.8%). However, the cut-off could be substantially lowered to ≥13.80, while still maintaining adequate specificity (≥90%), and raising sensitivity to 70.0%. Examination of non-credible subgroups revealed that Dot Counting Test sensitivity in feigned mild traumatic brain injury (mTBI) was 55.8%, whereas sensitivity was 90.6% in patients with non-credible cognitive dysfunction in the context of claimed psychosis, and 81.0% in patients with non-credible cognitive performance in depression or severe TBI. Thus, the Dot Counting Test may have a particular role in detection of non-credible cognitive symptoms in claimed psychiatric disorders. Alternative to use of the E-score, failure on ≥1 cut-offs applied to individual Dot Counting Test scores (≥6.0″ for mean grouped dot counting time, ≥10.0″ for mean ungrouped dot counting time, and ≥4 errors), occurred in 11.3% of the credible sample, while nearly two-thirds (63.6%) of the non-credible sample failed one of more of these cut-offs. Conclusions: An E-score cut-off of 13.80, or failure on ≥1 individual score cut-offs, resulted in few false positive identifications in credible patients, and achieved high sensitivity (64.0-70.0%), and therefore appear appropriate for use in identifying neurocognitive performance invalidity. [ABSTRACT FROM AUTHOR]

Objective:The current study evaluated MSPQ sensitivity to noncredible PVT performance in the context of external incentive, and examined MSPQ false positive rates in noncompensation-seeking neuropsychology patients; and investigated effects of ethnicity/culture, gender, and somatoform diagnosis on MSPQ scores, and relationships with PVT and MMPI-2-RF data.Method:MSPQ scores were compared in credible (n = 110) and noncredible (n = 153) neuropsychology referrals.Results:Noncredible patients scored higher than credible patients. When the credible group was divided into those with somatoform orientation (n = 39) versus those without (n = 71), the credible nonsomatoform group scored lower than the other two groups, who did not differ from each other. MSPQ elevations were found in ethnic minorities, and in individuals who learned English as a second language or concurrently with another language. MSPQ elevations were also associated with chronic systemic diseases, neurologic illness, and substance abuse. Women scored higher than men, but men and women were equally represented among those patients scoring beyond cut-offs. MSPQ scores were minimally related to PVT data but were more strongly correlated with MMPI-2-RF scales, particularly over-report validity scales, RC1, and Somatic/Cognitive scales, with more widespread relationships observed in noncredible patients.Conclusions:A cut-off of 18 resulted in few false positives in credible nonsomatoform patients, and appears appropriate for identifying physical symptom over-report (due to malingering or somatoform orientations), with associated sensitivity of 29%. However, clinicians are cautioned regarding using the MSPQ in patients with systemic, neurologic, and substance abuse conditions, and in ethnic minorities and non-monolingual English-speakers. [ABSTRACT FROM PUBLISHER]

Objectives:To address (1) Whether there is empirical evidence for the contention of Nichols and Gass that the MMPI-2/MMPI-2-RF FBS/FBS-r Symptom Validity Scale is a measure of Litigation Response Syndrome (LRS), representing a credible set of responses and reactions of claimants to the experience of being in litigation, rather than a measure of non-credible symptom report, as the scale is typically used; and (2) to address their stated concerns about the validity of FBS/FBS-r meta-analytic results, and the risk of false positive elevations in persons with bona-fide medical conditions.Method:Review of published literature on the FBS/FBS-r, focusing in particular on associations between scores on this symptom validity test and scores on performance validity tests (PVTs), and FBS/FBS-r score elevations in patients with genuine neurologic, psychiatric and medical problems.Results:(1) several investigations show significant associations between FBS/FBS-r scores and PVTs measuring non-credible performance; (2) litigants who pass PVTs do not produce significant elevations on FBS/FBS-r; (3) non-litigating medical patients (bariatric surgery candidates, persons with sleep disorders, and patients with severe traumatic brain injury) who have multiple physical, emotional and cognitive symptoms do not produce significant elevations on FBS/FBS-r. Two meta-analytic studies show large effect sizes for FBS/FBS-r of similar magnitude.Conclusions:FBS/FBS-r measures non-credible symptom report rather than legitimate experience of litigation stress. Importantly, the absence of significant FBS/FBS-r elevations in litigants who pass PVTs demonstrating credible performance, directly contradicts the contention of Nichols and Gass that the scale measures LRS. These data, meta-analytic publications, and recent test use surveys support the admissibility of FBS/FBS-r under bothDaubertand the olderFryecriteria. [ABSTRACT FROM PUBLISHER]

We reply to Nichols’ (2017) critique of our commentary on the MMPI-2/MMPI-2-RF Symptom Validity Scale (FBS/FBS-r) as a measure of symptom exaggeration versus a measure of litigation response syndrome (LRS). Nichols claims that we misrepresented the thrust of the original paper he co-authored with Gass; namely, that they did not represent that the FBS/FBS-r were measures of LRS but rather, intended to convey that the FBS/RBS-r were indeterminate as to whether the scales measured LRS or measured symptom exaggeration. Our original commentary offered statistical support from published literature that (1) FBS/FBS-r were associated with performance validity test (PVT) failure, establishing the scales as measures of symptom exaggeration, and (2) persons in litigation who passed PVTs did not produce clinically significant elevations on the scales, contradicting that FBS/FBS-r were measures of LRS. In the present commentary, we draw a distinction between the psychometric data we present supporting the validity of FBS/FBS-r, and the conceptual, non-statistical arguments presented by Nichols, who does not refute our original empirically based conclusions. [ABSTRACT FROM PUBLISHER]

The current study provides specificity data on a large sample (n= 115) of young to middle-aged, male, monolingual Spanish speakers of lower educational level and low acculturation to mainstream US culture for four neurocognitive performance validity tests (PVTs): the Dot Counting, the b Test, Rey Word Recognition, and Rey 15-Item Plus Recognition. Individuals with 0 to 6 years of education performed more poorly than did participants with 7 to 10 years of education on several Rey 15-Item scores (combination equation, recall intrusion errors, and recognition false positives), Rey Word Recognition total correct, and E-score and omission errors on the b Test, but no effect of educational level was observed for Dot Counting Test scores. Cutoff scores are provided that maintain approximately 90% specificity for the education subgroups separately. Some of these cutoffs match, or are even more stringent than, those recommended for use in US test takers who are primarily Caucasian, are tested in English, and have a higher educational level (i.e., Rey Word Recognition correct false-positive errors; Rey 15-Item recall intrusions and recognition false-positive errors; b Test total time; and Dot Counting E-score and grouped dot counting time). Thus, performance on these PVT variables in particular appears relatively robust to cultural/language/educational factors. [ABSTRACT FROM PUBLISHER]

The purpose of this archival study was to identify performance validity tests (PVTs) and standard IQ and neurocognitive test scores, which singly or in combination, differentiate credible patients of low IQ (FSIQ ? 75;n= 55) from non-credible patients. We compared the credible participants against a sample of 74 non-credible patients who appeared to have been attempting to feign low intelligence specifically (FSIQ ? 75), as well as a larger non-credible sample (n= 383) unselected for IQ. The entire non-credible group scored significantly higher than the credible participants on measures of verbal crystallized intelligence/semantic memory and manipulation of overlearned information, while the credible group performed significantly better on many processing speed and memory tests. Additionally, credible women showed faster finger-tapping speeds than non-credible women. The credible group also scored significantly higher than the non-credible subgroup with low IQ scores on measures of attention, visual perceptual/spatial tasks, processing speed, verbal learning/list learning, and visual memory, and credible women continued to outperform non-credible women on finger tapping. When cut-offs were selected to maintain approximately 90% specificity in the credible group, sensitivity rates were highest for verbal and visual memory measures (i.e., TOMM trials 1 and 2; Warrington Words correct and time; Rey Word Recognition Test total; RAVLT Effort Equation, Trial 5, total across learning trials, short delay, recognition, and RAVLT/RO discriminant function; and Digit Symbol recognition), followed by select attentional PVT scores (i.e., b Test omissions and time to recite four digits forward). When failure rates were tabulated across seven most sensitive scores, a cut-off of ? 2 failures was associated with 85.4% specificity and 85.7% sensitivity, while a cut-off of ? 3 failures resulted in 95.1% specificity and 66.0% sensitivity. Results are discussed in light of extant literature and directions for future research. [ABSTRACT FROM AUTHOR]

Neuropsychologists use performance validity tests (PVTs; Larrabee, 2012) to ensure that results of testing are reflective of the test taker’s true neurocognitive ability, and their use is recommended in all compensation-seeking settings. However, whether the type of compensation context (e.g., personal injury litigation versus disability seeking) impacts the nature and extent of neurocognitive symptom feigning has not been adequately investigated. PVT performance was compared in an archival data set of noncredible individuals in either a personal injury litigation (n= 163) or a disability-seeking context (n= 201). Individuals were deemed noncredible based on meeting Slick, Sherman, and Iverson’s (1999) criteria including failure on at least two PVTs and a lack of congruency between their low cognitive scores and normal function in activities of daily living (ADLs). In general, disability seekers tended to perform in a less sophisticated manner than did litigants (i.e., they failed more indicators and did so more extensively). Upon further investigation, these differences were in part accounted for by type of diagnoses feigned; those seeking compensation for mental health diagnoses were more likely to feign or exaggerate a wide variety of cognitive deficits, whereas those with claimed medical diagnoses (i.e., traumatic brain injury) were more targeted in their attempts to feign and/or exaggerate neurocognitive compromise. [ABSTRACT FROM AUTHOR]

Members of the National Academy of Neuropsychology were surveyed in 2005 to assess then current practices regarding Boston Naming Test (BNT) administration, interpretation, and reporting procedures. Nearly half of 445 respondents followed discontinuation rules that differed from instructions published with the test, and nearly 10% did not administer items in reverse order to achieve the required 8 consecutive item basal. Of further concern, between 40% and 55% of respondents indicated that they did not interpret BNT scores in light of linguistic and ethnic background, and over 25% reported that they did not consider educational level. Despite the fact that non-normal distribution of BNT test scores renders use of percentiles misleading, nearly 60% of respondents endorsed using percentiles when reporting BNT data. The implications of these results are discussed, and recommendations are provided. [ABSTRACT FROM PUBLISHER]

Practice guidelines recommend the use of multiple performance validity tests (PVTs) to detect noncredible performance during neuropsychological evaluations, and PVTs embedded in standard cognitive tests achieve this goal most efficiently. The present study examined the utility of the Comalli version of the Stroop Test as a measure of response bias in a large sample of "real world" noncredible patients (n = 129) as compared with credible neuropsychology clinic patients (n=233). The credible group performed significantly better than the noncredible group on all trials, but particularly on word-reading (Stroop A) and color- naming (Stroop B); cut-scores for Stroop A and Stroop B trials were associated with moderate sensitivity (49-53%) as compared to the low sensitivity found for the color interference trial (29%). Some types of diagnoses (including learning disability, severe traumatic brain injury, psychosis, and depression), very advanced age (⩾ 80), and lowered IQ were associated with increased rates of false positive identifications, suggesting the need for some adjustments to cut-offs in these subgroups. Despite some previous reports of an inverted Stroop effect (i.e., color-naming worse than color interference) in noncredible subjects, individual Stroop word reading and color naming trials were much more effective in identifying response bias. [ABSTRACT FROM AUTHOR]

The Rey Word Recognition Test, a brief and simple to administer free-standing neurocognitive performance validity test, was examined in a large known-groups sample (122 credible patients and 134 non-credible patients). Total correctly recognized was the most sensitive score, identifying 54% of non-credible participants using a cut-off of ≤6, while maintaining specificity of approximately 90%. However, specifically rates were somewhat lower in credible individuals with <12 years of education or borderline intelligence, or who were bilingual (spoke English as a second language, or learned English concurrently with another language), indicating that cut-offs may require minor adjustment in these groups. Sensitivity rates were much higher in non-credible female versus male mild traumatic brain injury patients (mTBI; 68% versus 48% for total correct), suggesting that the Rey Word Recognition Test is particularly effective in identifying performance invalidity in female mTBI compensation seekers. [ABSTRACT FROM PUBLISHER]

The b Test (Boone, Lu, & Herzberg, 2002a) is a measure of cognitive performance validity originally validated on 91 non-credible participants and 7 credible clinical comparison groups (totaln = 161). The purpose of the current study was to provide cross-validation data for the b Test on a known groups sample of non-credible participants (n = 212) and credible heterogeneous neuropsychological clinic patients (n = 103). The new data showed that while the original E-score cut-off of ≥155 achieved excellent specificity (99%), it was associated with relatively poor sensitivity (41%). However, the cut-off could be substantially lowered to ≥82, while still maintaining adequate specificity (≥90%) and raising sensitivity to 68%. Examination of non-credible subgroups revealed that b Test sensitivity in feigned mild traumatic brain injury (mTBI) was 58%, whereas in non-credible patients claiming depression and psychosis, cut-off sensitivity was 76% and 67%, respectively. These data suggest that the b Test may have a particular role in detection of non-credible cognitive symptoms associated with feigned psychiatric symptoms, and that fabricated deficits in processing speed and vigilance/visual scanning, detected by the b Test, are more prominent in feigned psychiatric presentations than in feigned mTBI. Further, b Test failures in patients with somatoform disorders were common, indicating that the b Test may have a specific use in detection of non-consciously created cognitive dysfunction associated with somatoform conditions. [ABSTRACT FROM PUBLISHER]

In the present study a large sample of credible patients (n = 172) scored significantly higher than a large sample of noncredible participants (n = 195) on several WAIS-III Picture Completion variables: Age Adjusted Scaled Score, raw score, a 'Rarely Missed' index (the nine items least often missed by credible participants), a 'Rarely Correct' index (nine items correct <26% of the time in noncredible participants and with at least a 25 percentage-point lower endorsement rate as compared to credible participants), and a 'Most Discrepant' index (the six items that were the most discrepant in correct endorsement between groups-at least a 40 percentage point difference). Comparison of the various scores showed that the 'Most Discrepant' index outperformed all the others in identifying response bias (nearly 65% sensitivity at 92.8% specificity as compared to at most 59% sensitivity for the other scores). While no differences in Picture Completion scores were observed between less-educated (<12 years) and better-educated (≥12 years) credible participants, noncredible participants with <12 years of education scored significantly poorer than noncredible participants with 12 or more years of education. On the 'Most Discrepant' index, 76.7% of less-educated noncredible participants were detected as compared to 58.3% of better-educated noncredible participants. Results of the current study suggest that the Picture Completion subtest of the WAIS-III is an effective measure of response bias, and that it may have a unique role in identifying suboptimal effort in less-educated test takers. [ABSTRACT FROM AUTHOR]

Identification of non-credible memory and other cognitive symptoms has received widespread attention within the past two decades. However, minimal information is available regarding patterns of non-credible language symptoms. We present the case of a 36-year-old female civil litigant who displayed delayed onset, severe, relatively focal speech and language symptoms, including difficulties with articulation, dysfluent speech, expressive language impairments with minor receptive difficulties, and lack of prosody, subsequent to a minor head trauma. On neuropsychological evaluation 3 years post injury, the patient presented with the same speech/language characteristics, but additionally exhibited a vague “foreign accent.” Cognitive scores generally were normal with the exception of poor performance on many language tasks and processing/motor speed. The patient showed passing performance on most measures of response bias, but she failed effort indicators requiring rapid letter discrimination (b Test), rapid verbal repetition (timed forward digit span), and sensory function (finger agnosia errors) while passing effort indicators falling within the domains of memory, math/number skills, visuo-constructional ability, and attention. Thus, the type of failed effort indicators predicted the categories of standard cognitive tests on which she underperformed. Personality testing revealed patterns generally consistent with hysterical personality orientation. Given her long-standing history of multiple unexplained medical symptoms, the patient was diagnosed with a somatization disorder, as well as a current conversion disorder involving language symptoms. However, given her compensation-seeking status, the possibility of additional conscious feigning of symptoms could not be ruled out. The need for validation of additional measures to detect feigned language impairment is recommended. [ABSTRACT FROM AUTHOR]

The assessment of response validity during neuropsychological evaluation is an integral part of the testing process. Research has increasingly focused on the use of “embedded” effort measures (derived from standard neuropsychological tasks) because they do not require additional administration time and are less likely to be identified as effort indicators by test takers because of their primary focus as measures of cognitive function. The current study examined the clinical utility of various WMS-III Logical Memory scores in detecting response bias, as well as the Rarely Missed Index, an embedded effort indicator derived from the WMS-III Logical Memory Delayed Recognition subtest. The Rarely Missed Index cut-off only identified 24.1% of 63 non-credible participants (at ≥90% specificity in 125 credible patients), and cut-offs for other Logical Memory variables were in fact found to be more sensitive to non-credible performance. A new indicator, consisting of the weighted combination of the two most sensitive Logical Memory subtest scores (Logical Memory II raw score and Logical Memory Delayed Recognition raw score), was associated with 53% to 60% sensitivity, and thus may be an effective adjunct when utilized in conjunction with other validated effort indicators and collateral information in identifying non-credible performance. [ABSTRACT FROM AUTHOR]

The effects of forensic examiner role on validity scores have rarely been studied empirically. We used a repeated measures design to examine the association between examiner role (plaintiff- and defense-selected neuropsychologists) and scores on eight Minnesota Multiphasic Inventory-2 validity scores (MMPI-2-VRIN, -TRIN, -L, -K, -F, -Fb, -Fp, and -FBS) of the same 80 individuals. All 80 were involved in litigation following mostly minor neurological injuries. We found no significant within-group differences on any of the MMPI-2 validity scales. Concordance of pass/fail rates between examinations was above 80%, except for MMPI-2-Fb. For example, the Symptom Validity Scale (MMPI-2-FBS) showed equivalently high failure rates (70%) during both examinations. This study does not support the view that examiner role affects symptom validity scores in forensic settings. [ABSTRACT FROM AUTHOR]

A subset of patients who present for neuropsychological testing report dysfunction in daily life activities secondary to cognitive deficits, but are found on formal testing to have no objective abnormalities, raising the possibility of “neurocognitive hypochondriasis.” Such a case is presented, and the factors that appear to give rise to this presentation are explored. Cases of hypochondriacal overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue syndrome, fibromyalgia, toxic mold exposure, and post-polio syndrome. [ABSTRACT FROM AUTHOR]

While most neuropsychologists are now administering measures of response bias in neuropsychological evaluations, it is still likely that detection of non-credible test performance is inadequate due to faulty assumptions regarding poor effort, namely that it remains constant across a battery of tests. Four cases are described that illustrate the variability in negative response bias that occurs during neuropsychological evaluations; if effort had not been periodically sampled with heterogeneous types of effort indicators during these examinations, the suspect performance would not have been detected. These examples argue for both continuous and comprehensive sampling of effort, specifically that negative response bias be routinely monitored throughout neuropsychological evaluations, and that effort indicators involving differing cognitive abilities be employed to assess for feigning of selective deficits. [ABSTRACT FROM AUTHOR]

While it is recommended that judgments regarding the credibility of test performance be based on the results of more than one effort indicator, and recent efforts have been made to improve interpretation of multiple effort test failure, the field currently lacks adequate guidelines for using multiple measures of effort in concert with one another. A total of 103 patients were referred for outpatient neuropsychological evaluation, which included multiple measures of negative response bias embedded in standard test batteries. Using any pairwise failure combination to predict diagnostic classification was superior (sensitivity = 83.8%, specificity = 93.9%, overall hit rate = 90.3%) to using any one test by itself and to using any three-test failure combination. Further, the results were comparable to the results of logistical regression analyses using the embedded indicators as continuous predictors. Given its parsimony and clinical utility, the pairwise failure model is therefore a recommended criterion for identifying non-credible performance; however, there are of course other important contextual factors and influences to consider, which are also discussed. [ABSTRACT FROM AUTHOR]

Research on the performance of patients with dementia on tests of effort is particularly limited. We examined archival data from 214 non-litigating patients with dementia on 18 effort indices derived from 12 tests (WAIS-III/WAIS-R Digit Span and Vocabulary, Dot Counting Test, Warrington Recognition Memory Test-Words, WMS-III Logical Memory, Rey Word Recognition Memory Test, Finger Tapping, b-Test, Rey 15-Item, Test of Memory Malingering, Rey Auditory Verbal Learning Test, and Rey Complex Figure Test). Results indicated that recommended cut-offs for Digit Span indicators (Vocabulary Minus Digit Span and four-digit forward span time score) provided ≥90% specificity across participants, while the majority of other effort tests displayed specificities in the 30-70% range. Analyses of test specificity as a function of Mini Mental Status Examination (MMSE) score and specific dementia diagnosis are provided, as well as adjustments to cut-offs to maintain specificity where feasible. [ABSTRACT FROM AUTHOR]

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Fake Bad Scale (FBS; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) has been shown to be sensitive to somatic over-endorsement. However, the impact of ethnicity has not been examined on the FBS, which is of concern given some studies that show increased rates of somatic endorsement in particular ethnic groups. We evaluated the FBS performance of 190 Caucasian American, Hispanic, and African American outpatients who were obtained from two different clinical settings, excluding those who were applying for disability or in litigation. We failed to find significant ethnic differences in mean FBS performance or in cut-off specificity rates. We did find evidence of a gender effect, supporting continued use of gender-specific FBS cutoffs. [ABSTRACT FROM AUTHOR]

The relationship between IQ and nine effort indicators was examined in a sample of 189 neuropsychology clinic outpatients who were not in litigation or attempting to obtain disability. Participants with the lowest IQ (50-59) failed approximately 60% of the effort tests, while patients with an IQ of 60 to 69 failed 44% of effort indicators, and individuals with borderline IQ (70 to 79) exhibited a 17% failure rate. All patients with IQ < 70 failed at least one effort test. Cutoffs for the Warrington Recognition Memory Test (Words) and Finger Tapping maintained the highest specificities in low IQ samples. [ABSTRACT FROM AUTHOR]

The Rey Word Recognition Test potentially represents an underutilized tool for clinicians to use in the detection of suspect effort. The present study examined the predictive accuracy of the test by examining the performance of three groups of participants: (a) 92 noncredible patients (as determined by failed psychometric and behavioral criteria and external motive to feign), (b) 51 general clinical patients with no motive to feign, and (c) 31 learning disabled college students. Results demonstrated gender differences in performance that necessitated separate cutoff scores for men and women. Use of a cutoff score of ≤7 words correctly recognized identified 80.5% of noncredible female patients while maintaining specificity of >90%. However, to achieve this level of specificity in male noncredible patients, the cutoff score had to be lowered to ≤5, with resultant sensitivity of only 62.7%. A combination variable (recognition correct minus false positive errors + number of words recognized from the first 8 words) showed enhanced sensitivity in identifying suspect effort in a subset of the noncredible sample who were claiming cognitive symptoms secondary to traumatic brain injury (i.e., cutoff score of ≤9 = 81.6% sensitivity with 90% specificity). Results indicate that the Rey Word Recognition Test is an accurate and cost-effective method for the detection of noncredible cognitive performance. [ABSTRACT FROM AUTHOR]

This article reports six cases of litigants claiming neuropsychiatric impairment due to toxic mold exposure. In spite of recent growth in personal injury claims due to mold, numerous reviews of the literature have failed to find an association between environmental exposure to mold and neuropsychiatric and/or neuropsychological damage. We report data on six patients claiming harm, 4 of whom revealed a long history of somatization by history and psychological testing, and 2 of whom were shown to be malingering based on multiple indicators of non-credible performance. Of the 6 patients, only the 2 somatoform patients who were also depressed showed credible evidence of neuropsychological dysfunction. We review two other studies that have examined the link between mold exposure and cognitive impairment and discuss their limitations in view of the presenting behaviors of these 6 patients. Until the literature has established a credible link between mold and neuropsychiatric/neuropsychological impairment, jurists and clinicians must consider the ethics and potential harm of exposing somatoform patients to multiple unwarranted medical evaluations. Principles for forensic evaluations in this special population are reviewed. [ABSTRACT FROM AUTHOR]

Information is lacking regarding the prevalence of fraudulent psychiatric and cognitive symptoms in the “stress” claim workers' compensation population. Using various validity indices (Negative Impression Scale, the Malingering Index, and the Rogers Discriminant Function) of the Personality Assessment Inventory (PAI), between 9 and 29% of 233 workers' compensation “stress” claim litigants were identified as exhibiting noncredible psychiatric symptoms. In addition, 15% of the subjects were determined to have noncredible cognitive symptoms on the Dot Counting Test, although only 8% displayed suspect effort on the 15-Item Memorization Test, with 5% of subjects failing both cognitive effort tests. The percentage of positive identifications on both a PAI and cognitive credibility index ranged from only 2 to 4%. Further, correlations between PAI validity indices and cognitive effort scales were nonexistent to modest, indicating that the psychiatric and cognitive credibility indices are measuring different aspects of noncredible symptom production. It was predicted that the PAI profiles of the participants displaying suspect cognitive symptoms would be elevated on the Somatic Concerns, Antisocial, and/or Borderline scales; however, elevations (relative to subjects with credible cognitive performance) were instead noted on the Somatic Concerns, Depression, Anxiety, Anxiety-Related Disorders, and Schizophrenia scales. [ABSTRACT FROM AUTHOR]

Ecological validity studies that have examined the relationship between cognitive abilities and employment in psychiatric and medical populations have found that a wide range of cognitive domains predict employability, although memory and executive skills appear to be the most important. However, no information is available regarding a patient's self-perceived work attributes and objective neuropsychological performance, and whether the same cognitive domains associated with successful employment are also related to a patient's self-perception of work competence. In the present study, 73 medical and psychiatric patients underwent comprehensive neuropsychological assessment. Step-wise multiple regression analyses revealed that the visual-spatial domain was the only significant predictor of self-perceived work attributes and work competence as measured by the Working Inventory (WI) and the Work Adjustment Inventory (WAI), accounting for 7% to 10% of inventory score variability. The results raise the intriguing possibility that targeting of visual spatial skills for remediation and development might play a separate and unique role in the vocational rehabilitation of a lower SES population, specifically, by leading to enhanced self-perception of work competence as these individuals attempt to enter the job market. [ABSTRACT FROM AUTHOR]

To examine the adequacy of the WMS-III in the identification of memory deficits in older individuals, we administered the Word Lists subtest, along with a comparison measure, the Rey Auditory Verbal Learning Test (RAVLT), to four patients referred for assessment of dementia. Although the number of words recalled by the patients on the delayed trials of the Word Lists subtest and RAVLT were nearly identical, norms for the Word Lists subtest indicated that memory performance was within normal limits (i.e., low average or higher), while the RAVLT norms accurately characterized performance as impaired. We suspect that normative data for the WMS-III were compromised by inadvertent inclusion of older subjects with dementia or mild cognitive impairment. The findings from our cases call into question the use of the WMS-III Word Lists for older patients. [ABSTRACT FROM AUTHOR]

Digit Span Age-Corrected Scaled Score (ACSS) and Reliable Digit Span (RDS) have been suggested as effective in assessing credibility. The purpose of this study was to confirm the efficacy of suggested cutoffs for ACSS and RDS and to explore the utility of other Digit Span variables in a large sample (N = 66) of “real-world” ≥ suspect effort patients versus clinic patients with no motive to feign (N = 56) and controls (N = 32). With specificity at ≥ 90%, sensitivity of ACSS increased from 32% to 42% when a ≤ 5 cutoff was used instead of the recommended ≤ 4. The RDS recommended cutoff of ≤ 7 resulted in a sensitivity of 62% but with an unacceptably high false positive rate (23%); dropping the cutoff to ≤ 6 raised the specificity to 93% but sensitivity fell to 45%. Cutoffs for other Digit Span scores did not exceed 45% sensitivity with the exception of 50% sensitivity (11% false positive rate) for average time per digit for all attempted items > 1.0 second. A criterion of ACSS ≤ 5 or RDS ≤ 6 was associated with 51% sensitivity (91% specificity) while RDS ≤ 6 or longest string with at least one item correct ≤ 4 was associated with 54% sensitivity (88% specificity). While only moderately sensitive, Digit Span scores, including new time variables, may have a unique and effective role in the detection of suspect effort. [ABSTRACT FROM AUTHOR]

Past studies indicate that patients with incentive to fake neuropsychological symptoms are likely to have lower finger tapping scores than credible patients. The present study builds upon past research by investigating finger tapping performance for seven groups: (a) noncredible patients (as determined by failed psychometric and behavioral criteria), and patients with (b) closed head injury, (c) dementia, (d) mental retardation, (e) psychosis, or (f) depression, and (g) healthy older controls. Results showed that men tapped faster than women, requiring that groups be divided by gender. Noncredible male and female patients tapped slower than their comparison group counterparts. Dominant hand score proved to be more sensitive to noncredible performance than other scores (nondominant, sum of both hands, difference between dominant and nondominant), especially for women. Sensitivity, specificity, and positive and negative predictive values tables are presented. With specificity set at 90% for the comparison groups combined, a dominant hand cutoff score of =35 for men yielded 50% sensitivity, while a score of =28 yielded 61% sensitivity for women. Specificity values for specific cutoff scores varied significantly across the comparison groups, indicating that cutoffs should be adjusted for the particular differential diagnosis. In conclusion, results indicate that when using finger tapping scores to detect noncredible performance: (a) Dominant hand performance is more sensitive, and (b) cutoffs should be selected based on gender and claimed diagnosis. [ABSTRACT FROM AUTHOR]

A recent qualitative scoring method for the Rey--Osterrieth Complex Figure (ROCF), the Boston Qualitative Scoring System (BQSS), purports to assess visuospatial organization, visual memory and executive function by using multiple series of scores with well-defined criteria. The first objective of this study was to determine whether the BQSS scores correlated with scores derived from the traditional Osterrieth scoring method and which method was more efficient at separating the diagnostic groups. The second objective was to correlate the BQSS executive scores to other nonverbal and verbal tests of executive function, working memory, processing speed, and episodic memory to determine what cognitive abilities the BQSS scores were measuring. The subjects, older depressed patients and healthy controls, were free of any clinical sign of incipient dementia or comorbid neurological disease. Their ROCF drawings were scored using both the Osterrieth and BQSS methods. The BQSS summary drawing scores correlated well with the Osterrieth summary scores for the copy and short-delay recall phases, the percent retained over the delay period and recognition. The BQSS executive scores for Planning, which included both copy and recall phases, correlated with Matrix Reasoning indicating that they assessed nonverbal reasoning but they did not correlate with other traditional executive tests. Planning also contributed to the separation of diagnostic groups and was the most effective score for predicting the percent of the ROCF retained over a short delay. The remaining executive scores did not show a pattern of correlations with other nonverbal executive or working memory scores that would satisfy concerns regarding their interpretation or internal validity when used in an older and/or depressed population. No differences emerged between the two scoring methods in their efficiency for predicting depression. [ABSTRACT FROM AUTHOR]

We present 6 patients who displayed noncredible effort on neuropsychological testing (verified by failures on specialized measures designed to discreetly assess effort status and multiple behavioral inconsistencies) and complained of complete illiteracy secondary to impoverished educational history, learning disability, or acquired brain injury. The Stroop Test, a measure of a specific aspect of executive function requiring inhibition of an automatized oral reading response in favor of a less habitual, competing color-naming response, was administered to these patients. All six subjects claimed that they were unable to perform the Word-Reading trial as a consequence of total reading disability, but on the Color-Word Interference trial, they all committed "errors" by reading the written words. Five of the six subjects also performed substantially slower on the Interference condition relative to the Color-Naming trial, indicating that they were in fact inhibiting a reading response. However, in cases involving complaints of complete reading illiteracy, the observation of these individuals performing an act that they claimed to be unable to do was the most powerful and pathognomonic indicator of deliberate feigning or exaggeration of impairment in these cases. [ABSTRACT FROM AUTHOR]

Examines the performance of recreational MDMA users compared to normal control subjects on several neuropsychological tests. Absence of differences in cognitive functioning between the MDMA users and normal controls; Association of greater use of MDMA with poorer scores on several measures of nonverbal memory; Finding that greater frequency users evidenced lower scores on nonverbal memory tests compared to lesser frequency users; Results suggesting that a subgroup of MDMA patients, especially heavy MDMA users, evidence declines in nonverbal memory.

The Rey-Osterrieth Complex Figure Test (ROCFT) is a popular measure of visuoconstructive skills and visual memory. a recognition memory trial was recently developed by Meyers and Meyers (1995) and attached to the standard administration of the ROCFT. The addition of this recognition paradigm (comprised of 12 small designs from the original ROCFT stimulus interspersed among 12 foils) makes ROCFT a potentially useful instrument in capturing suspect effort because patients attempting to feign memory difficulties typically operate from the misconception that recognition memory is as impaired as free recall in brain injury and, as a result, suppress recognition performance. The ROCFT (copy, immediate recall[i.e., 3-min recall], and the recognition trial) was administered to four sets of participants: 58 patients with suspect effort; 23 neuropsychology clinic patients with verbal memory impairment. 17 clinic patients with visual memory impairment, and 30 clinic patients without memory impairment. Group comparisons revealed significant group differences in direct copy, immediate recall, and recognition scores of the ROCFT (p < .0001), with the suspect effort group displaying significantly lower performance on the copy and immediate recall scores than the verbal memory impaired and nonmemory impaired clinic patient groups, and significantly lower recognition scores tan all three clinical groups. Furthermore, qualitative examination of the recognition trial revealed the presence of "atypical recognition errors" that were endorsed with significantly higher frequency by the suspect effort patients. A combination score incorporating the copy, true positive recognition, and a typical recognition error scores yielded a sensitivity of 74% while misclassifying only approximately 4% of verbal memory impaired clinic patients, 12% of visual memory impaired clinic patients, and 3% of nonmemory impaired clinic patients. [ABSTRACT FROM AUTHOR]

Discusses a study that assessed the relationship between eight measures that can be used to assess effort in a sample of patients in litigation or attempting to obtain and maintain disability compensation and who displayed noncredible symptoms based on psychometric performance and behavioral criteria. Correlations observed between test summary scores; Individual test scores reflecting indices of response time, free recall, recognition and false positive errors.

A frontal, or executive, variant of Alzheimer's disease (EAD) has been described in the literature in which frontal dysfunction accompanies temporal and parietal changes in the early stages of the illness. However, no study has empirically investigated associated aspects, such as neuropsychiatric symptoms, instrumental activities of daily living, or caregiver burden in this EAD subgroup. We compared the performance of two subgroups of mild Alzheimer's disease patients (e.g., EAD and typical Alzheimer's disease; TAD) on neuropsychological and associated measures. Results revealed that the EAD group, selected based on poor executive scores, did not significantly differ from the TAD group on nonexecutive neuropsychological tests of intelligence, language, verbal and nonverbal memory, or visual-spatial abilities. However, the EAD group evidenced more severe neuropsychiatric symptoms, impaired activities of daily living, and greater caregiver distress than the TAD group. Thus, the EAD subgroup is characterized by executive dysfunction, neuropsychiatric symptoms, and functional disability in excess of that seen in TAD. Whether our EAD subgroup represents an actual frontal variant of Alzheimer's disease awaits replication in a larger sample including neuroimaging and pathological confirmation, as well as longitudinal assessment of cognition and neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]

Bernard (1990), and Bernard, Houston, and Natoli (1993) identified a discriminant function, derived from Rey figure recall score and RAVLT trial 1 and recognition, which discriminated simulators and controls with 77-85% accuracy. However, in the current study, application of the discriminant function to patients with suspect effort, brain injured patients, and controls, revealed excellent sensitivity (95%) but low specificity (33% for patients, 61% for controls). A new discriminant function using the same Rey figure and RAVLT scores, derived from actual patients with documented suspect effort and patients with confirmed brain injury, resulted in an overall classification of 85% correct, with only 16% of suspect effort and 15% of brain injured patients misidentified. Use of a discriminant function score of ≤ -.40 resulted in sensitivity of 71% while maintaining specificity of ≥ 91%. [ABSTRACT FROM AUTHOR]

Even though the veracity of children's claim of psychiatric symptomshas received increased attention in recent years, identification of noncredibleneuropsychological symptoms in children has been virtually overlooked in clinicalpractice and research. A case is presented of a 9-year-old child involvedin litigation regarding a head injury sustained when he was struck by a car.Neuropsychological evaluation revealed evidence of feigned cognitive symptoms;the child displayed noncredible performance on several specialized tests designedto discreetly assess effort and an atypical pattern of responses on standardcognitive measures, as well as discrepancies between neuropsychological scoresand tests administered in school and the rehab setting. Results demonstratethat children as young as 9 years of age are capable of feigning cognitiveimpairment, which highlights the need for routine evaluation of effort, irrespectiveof the age of the patient. [ABSTRACT FROM AUTHOR]

To our knowledge, no investigations have been undertaken to determine whether depression impacts performance on two commonly used tests to detect malingering of cognitive symptoms, the Rey 15-item Memorization Test and the Rey Dot Counting Test. This is a critical issue because of the high rate of depressive symptoms in patients with neurological conditions. It was hypothesized that depressed individuals, especially those with more severe depression, might be at risk for failing the tests, because these patients exhibit mild deficits in mental speed, visual perceptual/spatial skills, and visual memory, abilities required for successful completion of the malingering tests. However, examination of test performance in 64 older participants with major depression generally revealed very low false positive rates for most test scores, and severity of depression was unrelated to test scores. These results add to accumulating data supporting the validity of these cognitive malingering tests by documenting few false positive identifications. [ABSTRACT FROM AUTHOR]

Although the detection of conscious fabrication (i.e., malingering) of cognitive symptoms has been the recipient of burgeoning interest within the last 10 years in the empirical and clinical neuropsychological literature, whether conversion/somatization results in similarly noncredible cognitive profiles has not been formally investigated. Two thirds (13 of 19) of subjects with cognitive complaints and 1-3/3-1 code types on the MMPI/MMPI-2 showed evidence ofnoncredible cognitive performance (i.e., failure on malingering tests and/or a “malingering” pattern on standard neuropsychological tests). These results suggest that symptom fabrication associated with somatization/conversion personality orientations can extend to noncredible cognitive complaints and not just the oft-described physical manifestations. [ABSTRACT FROM AUTHOR]

Evaluates the Boston Qualitative Scoring System (BQSS) for the Rey-Osterrieth Complex Figure. Shortcomings of the Rey-Osterrieth figure; Concept of the BQSS; Advantages and disadvantages.