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Although there is an abundance of research on stand-alone and embedded performance validity tests and stand-alone symptom validity tests (SVTs), less emphasis has been placed on embedded SVTs. The goal of the current study was to examine the ability of embedded indicators within the Patient Competency Rating Scale (PCRS) to separately detect invalid cognitive and/or emotional/affective symptom responding.Participants included 299 veterans assessed in a VA medical center epilepsy monitoring unit from 2013-2017 (mean age = 48.8 years,In ANOVAs, SVT-C was significantly associated with all PCRS indices, while SVT-E was only significantly associated with the PCRS total, emotional, and interpersonal competency indices. Although the PCRS-T ≤ 90 had the strongest classification of SVT-C and SVT-E (specificities: .90, sensitivities: .44 to .50), PCRS index scores showed suggestive evidence of domain specificity, with PCRS-ADL ≤22, PCRS-C ≤ 20, and PCRS-CADL ≤45 best classifying SVT-C (specificities: .92, sensitivities: .33) and the PCRS-E ≤ 18 best classifying the SVT-E group (specificity: .93, sensitivity: .40).Results suggest the PCRS may be used to obtain clinically useful information while including embedded indicators that can assess cognitive and/or emotional/affective symptom invalidity.

Evaluators of examinees in forensic contexts must consider the potential for falsified or exaggerated psychiatric symptoms and/or cognitive deficits. A number of validated assessment tools assist evaluators in identifying those examinees who feign impairment; however, no comprehensive method has been established for consolidating data from multiple tests, interviews, behavioral observations, and collateral sources. The current pilot study preliminarily examined the interrater reliability and validity of a new forensic assessment tool, the Feigning Evaluation INtegrating Sources (FEINS), developed to guide evaluators in the comprehensive assessment of feigning by adding structure to the collection of relevant data. Fifty-eight male pretrial defendants undergoing restoration of competency to stand trial at a state forensic psychiatric center participated in the study. Results provided preliminary support for reliability in scoring the FEINS, construct validity, and predictive validity. FEINS items that assessed clinical presentation, and those that guided the use of test data, were more useful than items capturing historical/demographic data. Structured professional judgments developed using the FEINS appeared to be more accurate in predicting competency evaluators' perceptions of feigning than both unstructured clinical judgment (i.e., referring psychologist's perception of feigning) alone and test data alone, using hierarchical multiple regressions. Findings suggest that the FEINS may have practical utility in guiding clinical opinions regarding feigning across psychiatric, cognitive, and psycholegal/functional domains. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: There is increased concern for malingering in ADHD evaluations due to presence of incentives such as accommodations and medications. Although several validity tests are available to classify malingering in non-ADHD populations, there is no test with proven effectiveness to detect feigned ADHD. This study investigated the ability of the MARS Symptom Validity Index 4 (MARS SV-index 4) and two published validity tests (the Word Memory Test [WMT] and Clinical Assessment of Attention Deficit-Adult [CAT-A] Infrequency scale) to detect malingered ADHD. Method: The participants consisted of 68 young adults, 34 with ADHD. Participants completed the MARS, CAT-A, and WMT validity measures. Results: The MARS SV index-4 demonstrated higher sensitivity rates for simulated malingering (61.8%) at close to optimal specificity (88.2%) compared to two published tests (which had sensitivity 90%). Conclusion: The MARS shows good ability to detect feigned ADHD and appears to be useful for adult ADHD assessments.

Objective Individuals with early-onset dysexecutive Alzheimer’s disease (dAD) have high rates of failed performance validity testing (PVT), which can lead to symptom misinterpretation and misdiagnosis. Method The aim of this retrospective study is to evaluate rates of failure on a common PVT, the test of memory malingering (TOMM), in a sample of clinical patients with biomarker-confirmed early-onset dAD who completed neuropsychological testing. Results We identified seventeen patients with an average age of symptom onset at 52.25 years old. Nearly fifty percent of patients performed below recommended cut-offs on Trials 1 and 2 of the TOMM. Four of six patients who completed outside neuropsychological testing were misdiagnosed with alternative etiologies to explain their symptomatology, with two of these patients’ performances deemed unreliable based on the TOMM. Conclusions Low scores on the TOMM should be interpreted in light of contextual and optimally biological information and do not necessarily rule out a neurodegenerative etiology.

Dissociative amnesia, defined as an inability to remember important autobiographical experiences, usually of a stressful nature, is a controversial phenomenon. We systematically reviewed 128 case studies of dissociative amnesia reported in 60 articles that appeared in peer-reviewed journals in English over the past 20 years (2000–2020). Our aim was to examine to what extent these cases met core features of dissociative amnesia. All cases were about reports of autobiographical memory loss, but the evidence offered in support of a dissociative amnesia interpretation was often weak and plagued by an ambiguous heterogeneity with respect to nature, etiology, and differential diagnoses of alleged memory loss. Most case studies failed to rule out plausible alternative explanations of dissociative amnesia, such as ordinary forgetting and malingering. We encourage clinicians and researchers to more critically investigate alleged cases of dissociative amnesia and provide criteria for how a dissociative amnesia case ideally would look like.

The Self-Report Symptom Inventory (SRSI) was developed to expand the toolbox of self-report instruments available to detect symptom overreporting. Such instruments, today known as symptom validity tests, play a crucial role in both forensic evaluations and in a range of clinical referral questions. The SRSI was originally designed in the German language; items were selected from a larger pool on the basis of empirical results. Scores on the Structured Inventory of Malingered Symptomatology served as external criterion for the item selection procedure and empirical cut-score determination (gold standard). The SRSI is composed of five subscales describing potentially genuine symptoms and five pseudosymptoms subscales. Ten different language test versions have been developed so far. The article describes the background of the construction of the scale, the main empirical results with the SRSI, the conditions of use, and the limits of applicability. With research ongoing in several countries and with a variety of language versions, a larger body of empirical evidence can be expected to accumulate in the coming years.

To determine if the number of participants with psychiatric disorders increased in association with failures on symptom validity tests (SVTs) and a performance validity test (PVT) in Veterans admitted for evaluation of possible seizures.The 254 participants were Veterans undergoing inpatient video-EEG monitoring for the diagnosis of possible seizures. DSM-IV psychiatric disorders were diagnosed with the SCID IV. Symptom exaggeration was assessed with the MMPI-2-RF and performance validity with the TOMM.On the MMPI-2-RF, 27.6%-32.7% showed symptom exaggeration. Participants who exaggerated on the MMPI-2-RF were more often diagnosed with psychiatric disorders. The TOMM was failed by 15.4% of the sample. Participants who failed the TOMM were more often diagnosed with an Axis I disorder but not with a personality disorder. The MMPI-2-RF was invalid in more cases than the TOMM, but 7.9% of the sample generated a valid MMPI-2-RF and an invalid TOMM.The correlational design does not allow conclusions about cause and effect. The invalid groups may have had a higher rate of psychopathology. The number of participants with psychiatric disorders increased in association with symptom exaggeration and performance invalidity. Symptom exaggeration was more frequent than performance invalidity, but the TOMM made a unique contribution to identification of invalidity. The routine clinical use of SVTs and PVTs is supported. The results also suggest the need for caution in diagnosing psychiatric disorders when there is symptom exaggeration or performance invalidity, because diagnostic validity is dependent on the accuracy of symptom reporting.

This systematic review was performed to summarize existing research on the symptom validity scales within the Trauma Symptom Inventory–Second Edition (TSI-2), a relatively new self-report measure designed to assess the psychological sequelae of trauma. The TSI-2 has built-in symptom validity scales to monitor response bias and alert the assessor of non-credible symptom profiles. The Atypical Response scale (ATR) was designed to identify symptom exaggeration or fabrication. Proposed cutoffs on the ATR vary from ≥ 7 to ≥ 15, depending on the assessment context. The limited evidence available suggests that ATR has the potential to serve as measure of symptom validity, although its classification accuracy is generally inferior compared to well-established scales. While the ATR seems sufficiently sensitive to symptom over-reporting, significant concerns about its specificity persist. Therefore, it is proposed that the TSI-2 should not be used in isolation to determine the validity of the symptom presentation. More research is needed for development of evidence-based guidelines about the interpretation of ATR scores.

This project involves developing cut-off scores using the MMPI-2 to differentiate DID malingerers from genuine DID patients.

OBJECTIVE Using embedded performance validity (PVT) comparisons, Erdodi et al. suggested that Grooved Pegboard (GPB) T-score cutoffs for either hand (≤ 29) or both hands (≤ 31) could be used as additional embedded PVTs. The current study evaluated the relationship between these proposed cutoff scores and established PVTs (Medical Symptom Validity Test [MSVT]; Non-Verbal Medical Symptom Validity Test [NV-MSVT], and Reliable Digit Span [RDS]). METHOD Participants (N = 178) were predominately Caucasian (84%) males (79%) with a mean age and education of 41 (SD = 11.7) and 15.8 years (SD = 2.3), respectively. Participants were stratified as "passing" or "failing" the GPBviaErdodi's proposed criteria. "Failures" on the MSVT, NV-MSVT, and RDS were based on conventional recommendations. RESULTS Moderate correlations between GPB classification and a condition of interest (COI; i.e. at least two failures on reference PVTs) were observed for dominant (χ2 (1, n = 178) = 34.72, ϕ = .44, p < .001), non-dominant (χ2 (1, n = 178) = 16.46, ϕ = .30, p = .001), and both hand conditions (χ2 (1, n = 178) = 32.48, ϕ = .43, p < .001). Sensitivity, specificity, and predictive power were generally higher than Erdodi et al.'s initial findings. CONCLUSION These findingsprovide supportfor the clinical utility of the GPB as an additional embedded PVT. More specifically, dominant and both hand cutoffs were found to be more robust measures ofnon-genuine performance in those without motor deficits. While promising, sensitivity continues to be low; therefore, it is ill-advised to use the GPB as a sole measure of -performance validity.

Abstract. Early research on trauma employing the Rorschach found it to be an ideal instrument, with its red, black, gray, and vibrant colors, to elicit trauma content. Two patterns of Rorschach responses emerged: the constricted pattern, where the evaluee kept to a form-based, avoidant approach to the blot, as if defending against the memories of the trauma, and a flooded pattern, where morbid and aggressive images paralleled that of psychosis. The Rorschach as an instrument continues to demonstrate high sensitivity to the experience of trauma, and research since 2005 has added complexity and additional validation for the use of the Rorschach in the evaluation of the effects of trauma.

Objective In concussion populations, suboptimal task engagement detected by performance validity tests (PVTs) has been associated with poorer neuropsychological scores and greater post-concussive symptoms (PCS). This study examined if Pass/Fail status on the Test of Memory Malingering—TOMM Trial 1—differentiated the neurocognitive, emotional, and behavioral profile of pediatric patients with concussion. Method This study utilized archival data from 93 patients (mean age = 14.56 and SD = 2.01) with a history of concussion who were assessed at ~5–6 weeks post-injury (mean days = 40.27 and SD = 35.41). Individuals were divided into “Pass” and “Fail” groups based on TOMM Trial 1 performance. The testing battery included ACT, CPT-II and III, HVLT-R, WJ-III and IV ACH, ImPACT, BASC-2, and BRIEF. Results The overall pass rate on Trial 1 was 70% (mean = 46.04 and SD = 4.55). Findings suggested that a passing score on Trial 1 may be associated with adequate performance across the remaining two trials of the TOMM. The Fail group scored significantly lower across attention, memory, and processing speed measures when compared with the Pass group. On rating scales, significantly more concerns were endorsed with the Fail group for attention and executive functioning relative to the Pass group. Parents generally endorsed significantly more concerns for executive functioning when compared with their children’s self-reported symptoms. There was a trend for the Fail group to report more PCS; however, they did not significantly differ from the Pass group for depression, anxiety, or somatization. Conclusions This study highlights the importance of utilizing PVTs when evaluating concussion recovery.

Objective To cross-validate RAVLT performance validity cut-offs and the RAVLT/RO discriminant function in a large neuropsychological sample. Method RAVLT scores and the RAVLT/RO discriminant function were compared in credible (n = 100) and noncredible (n = 353) neuropsychology referrals. Results 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. Conclusions 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.

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) is a widely used but controversial instrument promulgated to measure malingering. Its use is encouraged by publications which are methodologically flawed such as the recent meta-analysis by Detullio et al. (2019). In this study, we examine which of M-FAST’s 25 items are most frequently endorsed by veterans with posttraumatic stress disorder (PTSD). Method: Using tabular data published by Wolf’s team in 2020, we identified from a clinical perspective, the 7 M-FAST items endorsed by the highest proportions of 121 US combat veterans with a probable current diagnosis of PTSD. Since the M-FAST diagnostic cutoff is 6 or more points and each endorsed item counts as one point, the 7 most frequently endorsed M-FAST items provide a clinical profile, via their content, as to which items are most frequently involved in misdiagnosing veterans as malingerers. Results and Discussion: Item 2 (“feeling depressed most of the time”) was endorsed by 67.8%, Item 23 (“feeling that I don’t really matter”) by 56.2%, Item 20 (formication) by 28.9%, and Item 17 (phantosmia, i.e., “false sensation of an odor”) by 24.0%. Formication and phantosmia are legitimate neuropsychological symptoms that may occur with whiplash injuries and head trauma or exposure to toxic chemicals in combat. Item 21 (“at times hearing music coming from nowhere”) endorsed by 22.3% may describe spontaneous intrapsychic activity of musically inclined persons. Item 14 (“Sometimes it seems as if someone controls my symptoms, turning them on and off”) endorsed by 20.7% may reflect the unpredictable fluctuation of frequency and severity of PTSD symptoms. Item 1 (“restlessness while seated”) endorsed by 19.8% is scored in the M-FAST as a discrepancy between the patient reporting that he “often” feels restless, and the examiner’s observation that no such nonverbal behavior during the brief M-FAST interview was noted. Restlessness is a post-concussive symptom that is not necessarily always present, such as during the M-FAST interview. Conclusions: All 7 most frequently endorsed items by combat veterans are neither exclusive to malingerers nor pathognomonic of malingering. They form a pattern of legitimate medical symptoms fallaciously scored and interpreted in the M-FAST’s system as indicators of malingering.

Forensic practitioners face continuing challenges in differentiating factitious presentations from malingering, which may be particularly salient in civil forensic cases. In striking contrast to malingering, very little research has studied factitious psychological presentations (FPPs). To address this virtual void, the Inventory of Self and Interpersonal Problems (I-SIP) was developed with two primary scales to address motivations: Factitious (FACT) and Antisocial Characteristics (ANT-C). The I-SIP was tested on 80 inpatients under both genuine and feigning (factitious or malingering) conditions. As predicted, factitious feigners evidenced a dramatic spike on the FACT scale that clearly differentiated it from the other conditions with 90% or higher accuracy. In addition, a ratio between the two primary scales improved the specificity between factitious and malingered presentations. Professional implications are discussed, including the use of the I-SIP as a preliminary alert for factitious presentations.

INTRODUCTION: Research has shown non-trivial base rates of noncredible symptom report and performance in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. The goal of this study is to estimate and replicate base rates of symptom and performance validity test failure in the clinical evaluation of adult ADHD and derive prediction models based on routine clinical measures.METHODS: This study reuses data of a previous publication of 196 adults seeking ADHD assessment and replicates the findings on an independent sample of 700 adults recruited in the same referral context. Measures of symptom and performance validity (one SVT, two PVTs) were applied to estimate base rates. Prediction models were developed using machine learning.RESULTS: Both samples showed substantial rates of noncredible symptom report (one SVT failure: 35.7% - 36.6%), noncredible test performance (one PVT failure: 32.1% - 49.3%; two PVT failures: 18.9% - 27.3%), or both (each one SVT and PVT failure: 13.3% - 22.4%; one SVT and two PVT failures: 9.7% - 13.7%). Machine learning algorithms resulted in generally moderate to weak prediction models, with advantages of the reused sample compared to the independent replication sample. Associations between measures of symptom and performance validity were negligible to small.CONCLUSIONS: This study highlights the necessity to include measures of symptom and performance validity in the clinical evaluation of adult ADHD. Further, this study demonstrates the difficulty to characterize the group failing symptom or performance validity assessment.

Background: The current study aimed to validate the utility of previously established validity indicators derived from MOXO-d-CPT’s continuous performance test. Method: Healthy simulators feigned impairment after searching online for relevant information, an ecologically valid coaching condition ( n = 39). They were compared to ADHD patients ( n = 36) and healthy controls ( n = 38). Results: Simulators performed significantly worse than ADHD patients in all MOXO-d-CPT indices, as well as a scale that integrates their contributions (feigned ADHD scale). Three indices (attention, hyperactivity, and impulsivity) and the latter scale exhibited adequate discriminative capacity. Higher education was associated with an exaggerated impairment among simulators, easing their detection. Conclusion: Similarity between the current study and a previous study which examned the utlity of the MOXO-d-CPT validity indicators, increases our confidence in the efficacy of the latters embedded validity indicators. Though the findings provide initial validation of these validity indicators, generalizing beyond highly functioning participants necessitates further research.

The purpose of this study was to evaluate relationships among the Word Memory Test (WMT), symptom validity test (SVT) indices of the Personality Assessment Inventory (PAI), history of mild traumatic brain injury (mTBI), and posttraumatic stress disorder (PTSD) symptom burden. Participants were postdeployment, predominantly male (88.5%) veterans (N = 417) who completed a neurocognition study that included the WMT and PAI. Correlations, chi-square analyses, and ANOVAs were used for analyses. Results of aim 1 examining relations among the two tests found that 20.4% produced invalid scores on the WMT (regardless of PAI scores), 13.8% produced an invalid PAI (regardless of WMT scores), and 4.6% were invalid on both tests. Of the 4 original PAI validity scales, only Negative Impression Management was related to WMT failure; the supplementary Malingering Index was also significant at a smaller effect size. The second aim evaluated mTBI and PTSD symptoms in relation to validity scores. History of mTBI was associated with invalid WMT scores but not PAI scores; follow-up analyses indicated that injuries sustained during deployment were significantly more likely to produce invalid WMT scores than non-deployment injuries. Contrary to hypotheses, PTSD symptom burden was related to WMT failure but not overreporting on the PAI. After dividing the sample into four groups based on valid versus invalid WMT and PAI scores, the invalid PVT valid SVT group had the highest proportion of mTBI, whereas PTSD symptom burden was highest in the groups that invalidated both measures or only the WMT. Service-connected disability status was unrelated to either type of validity. Given invalidating both types of validity measures is uncommon, the importance of sampling both types of validity is highlighted.

Background: The Miller Forensic Assessment of Symptoms Test (M-FAST) is used widely for the assessment of malingering of medical symptoms. Its validity has allegedly been supported by meta-analytic study of M-FAST in 2019 by Detullio et al. Credibility of Detullio’s results is damaged by an inclusion of data based on analog validation and also on dubious convergent validation procedures that falsify estimates of M-FAST’s validity. Method: In the present study, the meta-analysis was calculated on 3 types of M-FAST data: (1) 5 samples of scores of healthy persons instructed to respond honestly, (2) 5 samples of scores of medical patients, and (3) 10 samples of scores of healthy persons instructed to feign mental illness (so called “instructed malingerers”). Results: In an ANOVA (F(2,815)=398.50, p

Some self-report symptom validity tests, such as the Self-Report Symptom Inventory (SRSI), rely on a detection strategy that uses bizarre, extreme, or very rare symptoms. Thus, items are constructed to invite respondents with an invalid response style to affirm pseudosymptoms that are usually not experienced by genuine patients. However, these pseudosymptoms should not be easily recognizable, because otherwise sophisticated over-reporters could strategically avoid them and go undetected. Therefore, we tested how well future psychology professionals were able to differentiate between genuine complaints and pseudosymptoms in terms of their plausibility and prevalence.Psychology students (N = 87) received the items of the SRSI online and were given the task to rate each item as to its plausibility and prevalence in the community.Students evaluated genuine symptoms as significantly more plausible and more prevalent than pseudosymptoms. However, 56% of students rated pseudosymptoms as moderately plausible, whereas 17% rated them as moderately prevalent in the general public.Overall, it appears that psychology students are successful in distinguishing bizarre, unusual, or rare symptoms from genuine complaints. Yet, the majority of students still attributed relatively high prima facie plausibility to pseudosymptoms. We contend that if such a trusting attitude is true for psychology students, it may also be the case for young psychology practitioners, which, consequently, may diminish the probability of employing self-report validity measures in psychological assessments.

Introduction: Research to date has supported the use of multiple performance validity tests (PVTs) for determining validity status in clinical settings. However, the implications of including versu...

Objective This study examined the degree to which verbal and visuospatial memory abilities influence performance validity test (PVT) performance in a mixed clinical pediatric sample. Method Data from 252 consecutive clinical pediatric cases (Mage=11.23 years, SD=4.02; 61.9% male) seen for outpatient neuropsychological assessment were collected. Measures of learning and memory (e.g., The California Verbal Learning Test-Children’s Version; Child and Adolescent Memory Profile [ChAMP]), performance validity (Test of Memory Malingering Trial 1 [TOMM T1]; Wechsler Intelligence Scale for Children-Fifth Edition [WISC-V] or Wechsler Adult Intelligence Scale-Fourth Edition Digit Span indices; ChAMP Overall Validity Index), and intellectual abilities (e.g., WISC-V) were included. Results Learning/memory abilities were not significantly correlated with TOMM T1 and accounted for relatively little variance in overall TOMM T1 performance (i.e., ≤6%). Conversely, ChAMP Validity Index scores were significantly correlated with verbal and visual learning/memory abilities, and learning/memory accounted for significant variance in PVT performance (12%–26%). Verbal learning/memory performance accounted for 5%–16% of the variance across the Digit Span PVTs. No significant differences in TOMM T1 and Digit Span PVT scores emerged between verbal/visual learning/memory impairment groups. ChAMP validity scores were lower for the visual learning/memory impairment group relative to the nonimpaired group. Conclusions Findings highlight the utility of including PVTs as standard practice for pediatric populations, particularly when memory is a concern. Consistent with the adult literature, TOMM T1 outperformed other PVTs in its utility even among the diverse clinical sample with/without learning/memory impairment. In contrast, use of Digit Span indices appear to be best suited in the presence of visuospatial (but not verbal) learning/memory concerns. Finally, the ChAMP’s embedded validity measure was most strongly impacted by learning/memory performance.

Objective: The addition of Sequencing to WAIS-IV Digit Span (DS) brought about new Reliable Digit Span (RDS) indices and an Age-Corrected Scaled Score that includes Sequencing trials. Reports have indicated that these new performance validity tests (PVTs) are superior to the traditional RDS; however, comparisons in the context of known neurocognitive impairment are sparse. This study compared DS-derived PVT classification accuracies in a design that included adults with verified TBI. Methods: Participants included 64 adults with moderate-to-severe TBI (TBI), 51 healthy adults coached to simulate TBI (SIM), and 78 healthy comparisons (HC). Participants completed the WAIS-IV DS subtest in the context of a larger test battery. Results: Kruskal-Wallis tests indicated that all DS indices differed significantly across groups. Post hoc contrasts revealed that only RDS Forward and the traditional RDS differed significantly between SIM and TBI. ROC analyses indicated that RDS variables were comparable predictors of SIM vs. HC; however, the traditional RDS showed the highest sensitivity when approximating 90% specificity for SIM vs. TBI. A greater percentage of TBI scored RDS Sequencing < 1 compared to SIM and HC. Conclusion: In the context of moderate-to-severe TBI, the DS-derived PVTs showed comparable discriminability. However, the Greiffenstein et al. traditional RDS demonstrated the best classification accuracy with respect to specificity/sensitivity balance. This relative superiority may reflect that individuals with verified TBI are more likely to perseverate on prior instructions during DS Sequencing. Findings highlight the importance of including individuals with verified TBI when evaluating and developing PVTs.

Lysosomal storage diseases (LSDs) are a heterogeneous group of conditions causing substrate accumulation leading to progressive organ damage. Newborn screening (NBS) for several LSDs has become available in recent years due to advances in technology and treatment availability. While early initiation of treatment is lifesaving for those with infantile presentations, controversy continues regarding diagnosis of milder, later-onset diseases in infancy, including creation of pre-symptomatic populations of 'patients-in-waiting', the potential for medicalization, stigmatization, and/or discrimination. In-depth interviews were conducted with 36 adults [11 with Fabry disease (FD), 8 with Gaucher disease (GD), and 17 with late-onset Pompe disease (LOPD)], to determine their perspectives on NBS for their respective conditions. Thirty-four of 36 participants were in favor of NBS; both participants not in favor had GD1. Emergent themes influencing participants favorably toward NBS included earlier age of onset, a long diagnostic odyssey, less efficacious treatment, and the desire to have made different life decisions (e.g., relationships, career, or lifestyle) with the knowledge of their diagnosis. Concerns about insurance discrimination and psychological or physical burdens were associated with less favorable opinions of NBS. The ability for parents to make future reproductive decisions based their child's NBS result was considered favorably by some participants and unfavorably by others. Participants' specific condition (GD1, FD, or LOPD) contributed to these experiences differently. Participants with LOPD and FD favored NBS to initiate earlier treatment and prevent irreversible organ damage, whereas fewer patients with GD1 mentioned this benefit. Participants with LOPD had the longest diagnostic odyssey, while those with FD were more likely to report feeling misunderstood and experiencing accusations of malingering, both contributing to favorable views of NBS. Results expand prior quantitative findings by illuminating how participants' lived experiences can shape opinions about NBS. By understanding how currently affected individuals perceive the lifelong impact of a NBS result, genetic counselors can provide better anticipatory guidance to the parents of individuals diagnosed with a later-onset LSD by NBS.

Objective: Two studies examined the psychometric properties of the Multidimensional ADHD Rating Scale (MARS), which assesses ADHD symptoms, related functional impairment, and symptom validity (SV). Method: Study 1 used MARS item responses from college students with and without ADHD (with some of the latter group assigned to feign ADHD) to create an SV-index, and to identify optimal cut scores for the clinical (symptom and impairment) indexes. Study 2 cross-validated the findings on a new sample. Results: In both studies, malingerers reported more symptoms and impairment than participants with ADHD, who reported more symptoms and impairment than controls. Receiver operating characteristic analyses found very good discrimination of genuine ADHD from control cases by the clinical MARS indexes, and very good discrimination of genuine ADHD from malingered ADHD by the SV-index. Conclusion: This research provides initial support for the effectiveness of the MARS to detect simulated cases of malingering, and to differentiate ADHD from non-ADHD cases in college students.

Intentional faking and/or exaggeration of disability increase unnecessary burden and costs for society, and they could be difficult to detect. This study aimed to explore which and how eye-based me...

The Test of Memory Malingering (TOMM) Trial 1 (T1) and errors on the first 10 items of T1 (T1-e10) were developed as briefer versions of the TOMM to minimize evaluation time and burden, although th...

Evaluating the credibility of the respondent’s cognitive and psychological complaints is a core component of forensic mental health assessment. The Inventory of Problems-29 (IOP-29) and a new IOP-M...

While the psychometric equivalence of computerized versus paper-and-pencil administration formats has been documented for some tests, so far very few studies have focused on the comparability and validity of test scores obtained via in-person versus remote administrations, and none of them have researched a symptom validity test (SVT). To contribute to fill this gap in the literature, we investigated the scores of the Inventory of Problems-29 (IOP-29) generated by various administration formats. More specifically, Study 1 evaluated the equivalence of scores from nonclinical individuals administered the IOP-29 remotely (n = 146) versus in-person via computer (n = 140) versus in-person via paper-and-pencil format (n = 140). Study 2 reviewed published IOP-29 studies conducted using remote/online versus in-person, paper-and-pencil test administrations to determine if remote testing could adversely influence the validity of IOP-29 test results. Taken together, our findings suggest that the effectiveness of the IOP-29 is preserved when alternating between face-to-face and online/remote formats.

Background: Recent extensive content analyses demonstrated that the items of the Structured Inventory of Malingered Symptomatology (SIMS) have no capacity to differentiate malingerers from legitimate medical patients: all items list or assess legitimate medical symptoms. We examined which SIMS items are the most frequently endorsed by injured motorists. Method: De-identified archival data of 23 survivors (mean age=38.0, SD=12.8) of high impact motor vehicle accidents (MVAs) contained their SIMS scores, their responses to the Brief Pain Inventory, Morin’s Insomnia Severity Index, Rivermead Post-Concussion Symptoms Questionnaire, and to the Post-MVA Neurological Symptoms scale. Results: All SIMS items which were endorsed by more than 43% of the patients in the directions scored by the SIMS as indicative of “malingering” were selected. Twenty-five items met this criterion. On a closer examination, all these 25 items are legitimate psychological and neuropsychological symptoms typically experienced by injured motorists, such as depression, impaired sleep, and postconcussive symptoms (memory and concentration problems, impaired balance) and whiplash symptoms (numbness in the limbs, instances of reduced muscular control over some of the limbs). Discussion and Conclusions: The 25 endorsed items are consistent with the polytraumatic symptom profile of injured patients. In a travesty of psychological assessment, these symptoms are scored in the SIMS as denoting “malingering”.

Objective: The validity of neuropsychological test performance has scarcely been studied in patients with substance use disorders (SUD), despite the possibility that some SUD individuals may distor...

The Rey 15-item Test is a public-domain, memory-based performance validity test, frequently used in clinical settings. Various efforts have been made to modify the test to make it more sensitive and more robust to effects of lower education and intelligence. The most promising of these is the addition of a recognition trial to the existing free recall paradigm.The present study explored the use of the Rey-15 + Recognition Trial in a sample of 155 younger U.S. military veterans seen for evaluation of mild traumatic brain injury or attention deficit hyperactivity disorder (50 cases classified as invalid, 105 classified as valid).Optimal classification accuracy was obtained on the Combination index (cutoff ≤23, sensitivity = 50%, specificity = 95%) and the Recognition Hits score (cutoff ≤11, sensitivity = 52%, specificity = 93%). The Free Recall score had somewhat lower sensitivity when a similar 95% specificity threshold was set (cutoff ≤11, 38% sensitivity). A qualitative error score used in previous studies did not improve classification accuracy.The Rey-15 + Recognition Trial proved to be effective, with particular advantage bestowed by the recognition trial. Implications of these findings in the context of the study's clinical sample of military veterans and in the broader literature are discussed.

The jail‐based competency treatment (JBCT) model has become an established forensic practice across the country. From the perspective of implementation science and the three core elements of the Promoting Action on Research Implementation in Health Service (PARiHS) framework, the JBCT model is a remarkable example of how context (an unrelenting and overwhelmingly strong demand for forensic beds) has driven multiple state governments to facilitate implementation of a methodology in the absence of empirical evidence supporting its efficacy. This 7‐year study of outcomes from four JBCT program sites provides this much‐needed evidence by showing that JBCT restored 56% of 1553 male and 336 female patients over an average of 48.7 days. At the same time, the study highlights how variations in JBCT models, methods, and preadmission stabilization time present challenges to planned and effective implementation of evidence‐based practice at the statewide system level. By identifying differential responsiveness to JBCT treatment by diagnosis and other factors, the study suggests preliminary implementation ideas for what types of patients are well served by the JBCT model as part of a continuum of restoration options that includes inpatient, outpatient and diversion. Significant findings showed that JBCT patients were restored at a higher rate and in a shorter time if they were female, < 20 years old (highest restoration rate; those < 60 years old also significantly better rates), free of co‐occurring intellectual and cognitive deficits, and malingering. Of the major diagnoses, schizoaffective disorder required a significantly longer length of JBCT treatment for restoration, and lower restoration rates than schizophrenia and bipolar disorder, although this was moderated by a significant interaction with abuse of amphetamines.

The Memory Validity Profile (MVP) is a standalone performance validity test developed specifically for use with children. Prior research has demonstrated the MVP's strength in its ease of administration to children with a wide range of intellectual abilities. However, it has been found to lack sensitivity in detecting noncredible performance in select clinical populations using published cutoffs. The current study examines the MVP's performance in a diagnostically heterogeneous clinical sample and proposes a new cutoff for optimization of sensitivity and specificity. Archival clinical data were examined from 96 participants referred for a comprehensive neuropsychological evaluation (ages 6-18). Receiver operating characteristic analysis was used to assess the discriminative ability of MVP in detecting cases of noncredible performance defined as failures on both the Test of Memory Malingering and Reliable Digit Span. Using published cutoffs, the MVP demonstrated perfect specificity (100%) but suboptimal sensitivity (33.3%). Receiver operating characteristic analysis revealed strong discrimination using MVP Total score (AUC = 0.891 (

The Cognitive Bias Scale (CBS; Gaasedelen, Whiteside, Altmaier, Welch, & Basso, 2019) was developed as a Personality Assessment Inventory (PAI) indicator of poor performance on Performance Validity Tests (PVTs) in a neuropsychological context. The current study aimed to investigate the effectiveness of the CBS in a forensic disability sample through a series of analyses by comparing it to other PAI validity scales and the Minnesota Multiphasic Personality Inventory (MMPI)-2-RF overreporting scales with an emphasis on the Response Bias Scale (RBS), which guided the development of the CBS. The participants in this study were drawn from an archival dataset containing 588 consecutive civil disability claimants. Findings showed the RBS and the CBS yielded similar patterns of negative correlations to PVTs, with RBS effect sizes being somewhat larger in most comparisons. Results of ANOVAs showed that the RBS produced the largest effect sizes in distinguishing between incentive only versus probable/definite malingered neurocognitive dysfunction (MND) groups, followed by the CBS. Estimates of sensitivity and specificity were comparable between the RBS and CBS at liberal cut scores, but the RBS was more specific to detecting Probable/Definite MND at more conservative cutoffs. Hierarchical logistic regression analyses showed that RBS accounted for 6% variance over CBS in the probable/definite MND classification, whereas the CBS accounted for 2% variance beyond the RBS. Overall, the results of this study support the utility of the CBS as the most effective PAI validity scale for detecting MND in a civil disability sample, and the RBS generally outperformed the CBS to some degree in all analyses. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: The aim of this investigation was to provide information about the utility of the newly revised and renormed Minnesota Multiphasic Personality Inventory-3 (MMPI-3) over-reporting scales in a forensic disability sample. Method: Participants consisted of 550 non-head injury disability-related referrals (i.e. 95.6% for worker's compensation) and were primarily diagnosed with an adjustment disorder, depressive disorder, or posttraumatic stress disorder. Criterion measures included performance validity indicators and non-MMPI symptom validity indicators. Results: Correlation analyses showed that validity scale F was most strongly associated with non-MMPI symptom validity indicators, whereas F, Fs, FBS, and RBS were comparable to each other in their associations with performance validity indicators. Group mean comparisons between Pass versus Fail PVT groups showed that RBS consistently yielded the largest effect sizes. Using established structured criteria for Malingered Neurocognitive Dysfunction (MND), additional group mean comparisons showed that RBS, followed by Fs, F, and FBS, performed well in differentiating genuine responders from MND examinees. Classification accuracy estimates indicated that the MMPI-3 over-reporting scales performed well in the prediction of Probable/Definite MND and, as expected, to a lesser degree of Possible MND. Conclusions: Practical applications, study limitations, and directions for future research are discussed. The overall findings from this study provide empirical support for the utility of the MMPI-3 over-reporting scales in detecting negative response bias in forensic disability evaluations.

Recognition of the high prevalence of trauma exposure and posttraumatic stress symptoms among adult and youth offenders has inspired calls for justice systems to engage in trauma-informed practices, particularly with regard to the assessment of trauma histories and posttraumatic reactions in legal contexts. Accordingly, skills in trauma assessment have become essential professional competencies for those conducting psychological evaluations in the justice system. However, there are a number of challenges to effective practice, including the existence of two distinctly different sets of diagnostic criteria for posttraumatic stress disorder (PTSD) in the DSM-5 versus ICD-11; controversies over whether separate diagnostic entities comprising complex PTSD and developmental trauma disorder are valid; limitations of the existing measures for assessing and diagnosing the disorder(s); difficulties with differential diagnosis of overlapping disorders and detection of malingering; and limited attention to cultural, ethnic, and racial diversity in the idioms and expressions of posttraumatic stress reactions. The present article reviews these challenges and offers recommendations for future research and clinical practice.

Mild traumatic brain injury (MTBI) is a contentious topic in the field of psychological injury and law, especially in cases in which the symptoms persist in persistent post-concussion syndrome (PPCS). The article reviews 30 points related to MTBI/PPCS that workers in the field need to consider: understanding these syndromes, their symptoms, their prevalence, their causation, the influences and confounds in their diagnosis, best assessment practices, and legal aspects. Evaluators need to know the scientific literature, adopt an unbiased approach, undertake comprehensive assessments, consider all data and factors, and arrive at judicious decisions. The literature indicates few conclusive findings and conclusions related to MTBI/PPCS, except for finding much variability (even in terms of definition), uncertainty, inconclusiveness, and the need for extensive research. The literature supports the view that PPCS is biopsychosocial and that biological factors by themselves cannot account for MTBI/PPCS psychological presentations. The psychological factors can extent into symptom exaggeration, feigning, and malingering, and these confounds need to be assessed carefully before being ruled in or out. Ethically, evaluators should not have preconceived notions either way. When bias is evident in these regards, the weight of testimony or proffered reports in court and related venues will be reduced or they might be deemed inadmissible. As for recommendations, the article proposes that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), creates a new category termed somatic symptom disorder with predominant post-concussion-like symptoms. PPCS should not be considered a syndrome or anything related to the original index concussion/MTBI and should be dropped from the lexicon in the field.

Purpose The aim of this study was to investigate medical students' thought processes regarding whether to reveal the truth about a suspected malingering patient by analysing their book reports on Shalamov's Kolyma Tales (1974). Methods The participants were 47 medical students in their junior year. The book was provided a month before the classroom lecture. Students had discussions in groups of 7 and wrote book reports that included answers to 3 questions. Results Most students (39, 83.0%) answered that they had faked an illness previously, and abdominal pain (21, 53.8%) was the most frequently feigned illness. On the pre-reading questionnaire, 14 (29.8%) answered that they would reveal the truth by fair means or foul, whereas 15 (32.0%) would turn a blind eye to a malingering patient. On the post-reading questionnaire, however, 17 (36.2%) answered that they would reveal the truth, while 22 (46.8%) answered that they would turn a blind eye. It is notable that among the 18 students (38.2%) who replied that whether they would reveal the truth depended on the situation on the pre-reading questionnaire, 3 (6.3%) instead stated on the post-reading questionnaire that they would reveal the truth, while 7 (14.9%) answered that they would turn a blind eye. The remaining 8 (17.0%) did not change their mind and still replied that it depended on the situation. Conclusion It is thought that reading and discussing this story gave the students the opportunity to think about how to manage malingering patients, as portrayed in Shalamov's Kolyma Tales (1974).

Objective: This study examined concordance between symptom and performance validity among clinically-referred patients undergoing neuropsychological evaluation for Attention-Deficit/Hyperactivity Disorder (ADHD). Method: Data from 203 patients who completed the WAIS-IV Working Memory Index, the Clinical Assessment of Attention Deficit-Adult (CAT-A), and ≥4 criterion performance validity tests (PVTs) were analyzed. Results: Symptom and performance validity were concordant in 76% of cases, with the majority being valid performance. Of the remaining 24% of cases with divergent validity findings, patients were more likely to exhibit symptom invalidity (15%) than performance invalidity (9%). Patients demonstrating symptom invalidity endorsed significantly more ADHD symptoms than those with credible symptom reporting ( ηp2 = .06–.15), but comparable working memory test performance, whereas patients with performance invalidity had significantly worse working memory performance than those with valid PVT performance ( ηp2 = .18). Conclusion: Symptom and performance invalidity represent dissociable constructs in patients undergoing neuropsychological evaluation of ADHD and should be evaluated independently.

Objective To assess the validity of embedded measures of performance validity, the effort index (EI) and effort scale (ES) of the repeatable battery for the assessment of neuropsychological status (RBANS), in Veterans with seizures; to compare the frequency of failure on the test of memory malingering (TOMM) in patients with epileptic versus psychogenic nonepileptic seizures (PNES). Methods Seizure diagnosis was established for 309 participants in epilepsy monitoring units using conventional diagnostic criteria who completed both the TOMM and RBANS. The criterion for performance invalidity was failure on any trial of the TOMM. We examined multiple EI and ES cutoffs to establish optimal sensitivity and specificity. Results An RBANS EI cutoff score of greater than three was optimal with specificity of .98, sensitivity of.19, and positive Likelihood Ratio of 10 but was not useful when below this cutoff. Confidence intervals indicate the need for confirmation of a failed EI with another performance validity test (PVT). No ES cutoff had sufficient specificity for clinical use. Invalid TOMM performance but not invalid RBANS performance was significantly more common in persons with PNES than in persons with epileptic seizures. Conclusions In Veterans undergoing seizure monitoring, the RBANS EI was useful as a screen when positive that requires confirmation with another PVT. The RBANS ES was not useful. Invalid performance on the TOMM was more common in persons with PNES than in persons with epileptic seizures.

Objective This is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) in pediatric examinees. It adheres to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Method A systematic literature search was conducted using PsycINFO and PubMed, reviewing articles from January 1997 to July 2019. Books providing data on pediatric validity testing were also reviewed for references to relevant articles. Eligibility criteria included publication in a peer-reviewed journal, utilizing a pediatric sample, providing sufficient data to calculate specificity and/or sensitivity, and providing a means for evaluating validity status external to the TOMM. After selection criteria were applied, 9 articles remained for meta-analysis. Samples included clinical patients and healthy children recruited for research purposes; ages ranged from 5 to 18. Fixed and random effects models were used to calculate classification accuracy statistics. Results Traditional adult-derived cutoffs for Trial 2 and Retention were highly specific (0.96–0.99) in pediatric examinees for both clinical and research samples. Sensitivity was relatively strong (0.68–0.70), although only two studies reported sensitivity rates. A supplemental review of the literature corroborated these findings, revealing that traditional adult-based TOMM cutoffs are supported in most pediatric settings. However, limited research exists on the impact of very young age, extremely low cognitive functioning, and varying clinical diagnoses. Conclusions The TOMM, at traditional adult cutoffs, has strong specificity as a performance validity test in pediatric neuropsychological evaluations. This meta-analysis found that specificity values in children are comparable to those of adults. Areas for further research are discussed.

The SIMS is used in the medico-legal context to assess people who have suffered a traffic accident without proven scientific evidence to support this procedure. The objective of this research is to...

Introduction Malingering, defined as a deliberate attempt to lie or deceive in connection with an illness or disability, exaggerating the symptomatology, with the aim of obtaining a personal benefit, is a complex phenomenon, seldom studied in our professional context. The objective of this study was to analyse the way in which this phenomenon manifests itself in the forensic field. Material and methods An incidental sample of 190 subjects attended in the Psychology Unit (IMLCFC) over 16 months was selected. The Structured Inventory of Malingered Symptomatology (SIMS) was administered to them, while assessing certain clinical indicators of malingering and other psychometric results. A descriptive statistical analysis of the sample was performed, focusing on the correlations between clinical and psychometric suspicion, and on specific vs. generic test sensitivity. Results The structured clinical criterion to detect malingering correlates moderately with the result obtained in the SIMS; the total score in this test presents a positive, albeit attenuated, correlation with the exaggeration indicators from the main psychopathology test; malingering is a highly prevalent response style in subjects seeking work-related sickness compensation, with a pattern of significantly increased responses compared to that observed in criminal samples. Discussion The assessment of malingered psychological symptoms in the forensic context requires a multi-method strategy that includes structured clinical diagnosis, specific detection instruments, and other complementary psychometric tests, in order to generate convergent validity that contributes to the detection of this phenomenon.

Objective This study synthesized the results of 22 studies (N = 3,912) of feigned posttraumatic stress disorder (PTSD) symptoms that used the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Method Robust variance estimation was used to analyze variables that affected the accuracy of scales used to detect feigned symptoms. Results The FB scale (g = 1.60), the Obvious-Subtle scale (g = 1.57), and the Gough Dissimulation Index (F-K; g = 1.56) produced very large effect sizes after controlling for study design. Large and significant effect sizes were also observed for the F scale (g = 1.46), the FP scale (g = 1.43), and the Ds scale (g = 1.39). Conclusions The findings of this study suggest that the MMPI-2 validity scales are useful for identifying individuals who are exaggerating or fabricating psychological symptoms. However, there were differences across validity scales and study designs, with some scales demonstrating stronger performances than others. (PsycInfo Database Record (c) 2020 APA, all rights reserved).