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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 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.

You have probably heard the story. On the afternoon of 3 August 1943, while his 7th US Army battled the Germans across northern Sicily, Lieutenant General George S. Patton Jr. stopped outside Nicosia to visit the 15th Evacuation Hospital. The hard-pressed 1st Infantry Division's commander, Brigadier General Clarence R. Huebner had only recently warned him that "the front lines were getting thinner" because numerous soldiers malingered in the field hospitals to avoid combat.

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 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...

Kawasaki disease (KD) is a medium vessel vasculitis that predominantly affects children below 5. Diagnosis of KD is based on the presence of characteristic clinical manifestations as there are no definite diagnostic laboratory investigations for the diagnosis of this disease. Presence of atypical clinical features such as myositis often pose diagnostic challenge for the treating physicians. Presence of myositis and severe muscular weakness in KD is distinctly unusual and may lead to delays in diagnosis and administration of definite therapy. We report a 10-year-old boy who presented with fever, rash and proximal muscle and pharyngeal weakness. A clinical possibility of toxic shock syndrome or juvenile dermatomyositis was initially considered. However, he continued to have fever and developed periungual peeling of skin in fingers. Hence, a possibility of KD with myositis was considered. He showed prompt response to intravenous immunoglobulin and methylprednisolone. We also provide a review of similarly reported cases of KD myositis. It is important for clinicians to be aware of this atypical clinical presentation to avoid delays in diagnosis and treatment of KD.

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 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).

We describe a patient who presented with gender identity dysphoria and stroke-like symptoms who we diagnosed with Munchausen's syndrome (factitious disorder). We discuss whether a brain lesion in the left frontal cortex is a possible risk factor, and support this hypothesis through neuropsychological investigation, EEG abnormalities, and a personality assessment. This case report supports previous suggestions that underlying brain disease/lesions might be risk factors for Munchausen's syndrome (factitious disorder).

This study was designed to replicate previous research on embedded validity indicators (EVIs) in the Hopkins Verbal Learning Test - Revised (HVLT-R) and introduce a new forced choice recognition trial (FCR).Undergraduate research volunteers were randomly assigned (Recognition memory based EVIs (both existing and newly introduced) effectively discriminated credible and non-credible response sets. An FCR ≤11 produced .59 sensitivity and perfect specificity to invalid responding. A Recognition Discrimination (RD) score ≤8 also produced a good combination of sensitivity (.35) and specificity (.96). The FCR trial made unique contributions to performance validity assessment above and beyond previously published EVIs.RD achieved ≥.90 specificity at higher cutoffs than previously reported. The newly introduced FCR trial has the potential to enhance the existing arsenal of EVIs within the HVLT-R. However, it must demonstrate its ability to differentiate genuine impairment from non-credible responding before it can be recommended for clinical use.

Clinicians tend to overestimate their ability to recognize feigning behavior in psychiatric patients, especially if it concerns patients who have been admitted for observation. Feigning can be either externally motivated (e.g., for financial compensation, known as malingering) or internally motivated (e.g., to assume the "sick role," known as factitious disorder). Persistent presentation of severe symptoms is usually associated with the factitious disorder. We present two patients with strong external incentives who consistently and convincingly feigned severe psychiatric symptoms during a protracted period of inpatient observation in a specialized center; both were engaged in a procedure for medical asylum. The first case presented with the clinical picture of a psychotic depression with severe motor symptoms, and the second case showed symptoms of a chronic post-traumatic stress disorder with secondary psychotic symptoms. Both cases were thoroughly investigated but feigning was overlooked, and unnecessary and harmful treatment interventions were given. To prevent iatrogenic damage, we recommend a critical attitude that takes malingering as an option into account in settings where patients are often involved in high stake legal procedures. A clinical sign that might indicate feigning is therapy-resistant symptoms. To rule out feigning a comprehensive, multimethod approach is required, but an active stance toward collateral information is essential. Specialized psychological tests may be useful for preliminary screening, but for their use in culturally diverse populations as in refugee mental health more research is needed.

Validity indicators embedded within standard neuropsychological tests have received increasing attention as more efficient measures for sampling performance validity throughout an evaluation. This cross-sectional study examined multiple performance validity tests (PVTs) embedded in the Wechsler Adult Intelligence Scale-IV (WAIS-IV) Working Memory (WMI) and Processing Speed (PSI) Indices for detecting invalid test performance.This cross-sectional study examined data from a mixed clinical neuropsychiatric sample of 110 patients referred for outpatient evaluation. The sample was composed of 85 patients with valid neuropsychological performance and 25 with invalid performance based on multiple independent criterion PVTs. Among the patients with valid performance, 54% were cognitively impaired, whereas 46% were cognitively unimpaired.Among the overall sample, performance on WMI, PSI, and 3/4 constituent subtests (i.e., Digit Span, Symbol Search, Coding) was significantly worse among the invalid group compared to the valid group (Overall, results indicated that embedded WAIS-IV WMI and PSI are useful embedded PVTs in conditions in which cognitive impairment is not expected; however, these embedded PVTs demonstrated questionable utility among patients with cognitive impairment due to poor sensitivity, if adequate specificity is maintained, suggesting limited efficacy among patients with cognitive impairment due to risk of false-positive classification.

Objective The Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2005) is a 75-item self-report measure intended to screen for potentially feigned symptoms of mental illness and/or cognitive impairment. We investigated the classification accuracy of 2 new detection scales (Rare Symptoms [RS] and Symptom Combinations [SC]) developed by Rogers, Robinson, and Gillard (2014) that appeared useful in identifying simulated mental disorder in their derivation sample of psychiatric inpatients. Hypothesis We hypothesized that the rates of classification accuracy Rogers et al. reported for these 2 scales would generalize to other samples in which the utility of the SIMS previously has been investigated. Method We computed RS and SC scores from archival SIMS data collected as part of 3 research projects investigating malingering detection methods: (a) general population prison inmates and inmates in a prison psychiatric unit receiving treatment for mental disorder (N = 115), (b) college students (N = 196), and (3) community-dwelling adults (N = 48). Results Results supported the global classification accuracy of RS and SC but the suggested cut-score for both scales (>6) produced poor sensitivity. Lower potential cut-offs did, however, improve sensitivity to feigning somewhat while not excessively diminishing specificity. Conclusion These results emphasize the importance of generalizability research when investigating the clinical utility of forensic mental health assessment methods, particularly specific decision rules used to classify individuals into discrete categories. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Introduction: The Groningen Effort Test (GET) is a recently developed performance validity test (PVT) for the identification of noncredible performance in a neuropsychological assessment of attention abilities. Because the majority of already established PVTs are based on memory functions, the GET has the potential to make a valuable contribution to validity testing.Method: The current study examined the utility of the GET in the detection of feigned cognitive dysfunction after acquired brain injury (ABI) and its incremental validity over already established PVTs, namely the Test of Memory Malingering (TOMM), the Dot Counting Test (DCT), and the b Test. Three hundred and forty-eight participants took part in this study, including 58 patients with ABI (stroke or traumatic brain injury), 43 healthy individuals instructed to show normal behavior, and 247 healthy individuals instructed to feign cognitive dysfunction after ABI.Results: With excellent overall classification accuracy, the GET performed close to the level of the TOMM, and superior to the b Test and DCT. Data analyses further revealed that the GET provides additional diagnostic accuracy compared to the b Test and the DCT in the detection of feigned cognitive dysfunction, but has no incremental validity over the TOMM. For each of the four PVTs in this study, diagnostic sensitivity was independent of the simulation strategy used.Conclusions: It is concluded that the GET is an attention-based PVT with promising test characteristics and high diagnostic accuracy in the detection of noncredible cognitive performance using a simulation design. Given the results can be replicated in studies using known-groups methodology, it may be a useful tool for clinical practice to complement neuropsychological assessments of patients with ABI.

A malingering diagnosis can have consequences for patient care in the emergency room, hospital, and outpatient settings. Use of this diagnosis along racial and gender demographics has not been explored in clinical settings. To determine any differences in socio-demographic characteristics among patients diagnosed with malingering in non-psychiatric inpatient hospitals and emergency departments in the USA. The National Inpatient Sample (NIS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) databases were utilized to identify a malingering diagnosis from 2003 to 2015. Racial, ethnic, and gender disparities were examined. The malingering diagnosis is prevalent in 0.1% of both settings. The diagnosis is more prevalent in men than women. Among inpatients, malingering diagnosis was twice as prevalent among blacks compared with whites. The adjusted OR showed similar likelihood among blacks and whites with Hispanic men having the lowest likelihood for the diagnosis. Black women were slightly more likely, while Hispanic women were less likely to be diagnosed than white women. In ED settings, whites had the highest prevalence and a higher adjusted OR for malingering diagnosis compared with other races. There was no gender difference. The racial demographics of malingering diagnosis differ between clinical settings. Blacks may have a higher risk to receive the diagnosis as inpatients, whereas whites may have a higher risk in EDs. Hispanics have the lowest likelihood of the diagnosis in both settings. This data suggests a complex, multi-layered phenomenon highlighting how patients are diagnosed with malingering.

OBJECTIVE Eye-tracking is a promising technology to enhance assessment of performance validity. Research has established that ocular behaviors are reliable biomarkers of (un)conscious cognitive processes, and they have distinguished deceptive from honest responding in experimental paradigms. This study examined the incremental utility of eye-tracking on a clinical performance validity test (PVT) in distinguishing adults with verified TBI from adults coached to feign cognitive impairment. METHOD Participants were 49 adults with moderate-to-severe TBI (TBI), 47 healthy adults coached to simulate TBI (SIM), and 67 healthy comparisons providing full effort (HC). A PVT linked to eye-tracking was completed in the context of a full neuropsychological battery. RESULTS Kruskal-Wallis tests revealed that eye-tracking indices did not differ among the groups during presentation of stimulus items but did differ during forced-choice trials. Compared to TBI and HC, SIM had significantly more transitions, fixations, and time spent looking at correct and incorrect response options. Logistic regressions and ROC curve analyses showed that accuracy was the best predictor of SIM versus HC. For SIM versus TBI, eye-tracking indices exceeded accuracy in distinguishing the groups. Eye-tracking added incremental predictive value to accuracy for both SIM-HC and SIM-TBI discriminations. CONCLUSION Eye-tracking indicated that persons feigning TBI showed multiple signs of greater cognitive effort than persons with verified TBI and healthy comparisons. In the comparison of greatest interest (SIM vs. TBI) eye-tracking best predicted group status and yielded excellent discrimination when combined with accuracy. Eye-tracking may be an important complement to traditional accuracy scores on PVTs. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objective:Performance and symptom validity tests (PVTs and SVTs) measure the credibility of the assessment results. Cognitive impairment and apathy potentially interfere with validity test performance and may thus lead to an incorrect (i.e., false-positive) classification of the patient’s scores as non-credible. The study aimed at examining the false-positive rate of three validity tests in patients with cognitive impairment and apathy.Methods:A cross-sectional, comparative study was performed in 56 patients with dementia, 41 patients with mild cognitive impairment, and 41 patients with Parkinson’s disease. Two PVTs – the Test of Memory Malingering (TOMM) and the Dot Counting Test (DCT) – and one SVT – the Structured Inventory of Malingered Symptomatology (SIMS) – were administered. Apathy was measured with the Apathy Evaluation Scale, and severity of cognitive impairment with the Mini Mental State Examination.Results:The failure rate was 13.7% for the TOMM, 23.8% for the DCT, and 12.5% for the SIMS. Of the patients with data on all three tests (n = 105), 13.5% failed one test, 2.9% failed two tests, and none failed all three. Failing the PVTs was associated with cognitive impairment, but not with apathy. Failing the SVT was related to apathy, but not to cognitive impairment.Conclusions:In patients with cognitive impairment or apathy, failing one validity test is not uncommon. Validity tests are differentially sensitive to cognitive impairment and apathy. However, the rule that at least two validity tests should be failed to identify non-credibility seemed to ensure a high percentage of correct classification of credibility.

Introduction: This study examines the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity scales to detect invalid responding within a sample...

Much of the research on identifying feigning in psychological assessment has focused on adults with less attention to adolescents. The purpose of the present study is to expand the limited literature on detecting feigning in adolescents using the Personality Assessment Inventory - Adolescent. The study included 114 nonclinical adolescents (ages 15 to 18) recruited from high schools in the Midwest who were randomly assigned to experimental groups: honest nonclinical, uncoached feigning, and coached feigning. 50 randomly selected individuals with depression from the PAI-A clinical standardization sample were included as the honest clinical group. Sample demographics included a mean age of 16.64 years; 51.2% young men, 48.2% young women; 85.4% Caucasian, 6.7% African American, 5.5% Hispanic, and 2.4% Asian. 80% of feigning profiles reported clinical levels of depression. MANOVA results showed strong support for the Rogers Discriminant Function (RDF

Objective: Noncredible symptom claims, regularly expected in forensic contexts, may also occur in clinical and rehabilitation referral contexts. Hidden motives and secondary gain expectatio...

Introduction: This study evaluated symptom endorsement patterns in participants at various stratified performance levels on the Test of Memory Malingering (TOMM). It was hypothesized that the lowes...

Objective:Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.Method:Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).Results:Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.Conclusion:Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.

Invalid symptom report during assessment confounds the differential diagnosis process. This study examined differences in neuropsychological functioning between individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) and depression and/or anxiety disorders before and after participants meeting diagnostic criteria for malingered neurocognitive dysfunction were excluded. One hundred sixty-one adult patients undergoing ADHD assessment [M age 27.98 (8.35)] were evaluated and assigned to one of two groups based on medical records, a clinical interview, and self-report measures (depression/anxiety disorder n = 85; ADHD and depression/anxiety disorders n = 76). When all patients were considered, individuals with comorbid ADHD and depression/anxiety symptoms performed more poorly on 10 of 18 neuropsychological measures compared with those with only a depression/anxiety disorder (Cohen's d ranged from .32 to .72). In contrast, there was no evidence that the cumulative effect of ADHD and depression/anxiety resulted in diminished cognitive performance after excluding 54 patients with invalid symptom presentation. Additionally, the magnitude of association between self-report of ADHD symptoms and performance on neuropsychological test measures decreased dramatically. Thus, it is imperative that researchers administer performance and symptom validity measures to identify invalid symptom presentation when conducting large-scale studies. The failure to do so may result in inaccurate conclusions regarding the neurocognitive functioning of patients with ADHD and comorbid conditions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: The Self-Report Symptom Inventory (SRSI) is a new symptom validity test that, unlike other symptom over-reporting measures, contains both genuine symptom and pseudosymptom scales. We tested whether its pseudosymptom scale is sensitive to genuine psychopathology and evaluated its discriminant validity in an instructed feigning experiment that relied on carefully selected forensic inpatients (n = 40). Method: We administered the SRSI twice: we instructed patients to respond honestly to the SRSI (T1) and then to exaggerate their symptoms in a convincing way (T2). Results: On T1, the pseudosymptom scale was insensitive to patients’ actual psychopathology. Two patients (5%) had scores exceeding the liberal cut point (specificity = 0.95) and no patient scored above the more stringent cut point (specificity = 1.0). Also, the SRSI cut scores and ratio index discriminated well between honest (T1) and exaggerated (T2) responses (AUCs were 0.98 and 0.95, respectively). Conclusions: Given the relatively few false positives, our data suggest that the pseudosymptom scale of the SRSI is a useful measure of symptom over-reporting in forensic treatment settings.

Objective: The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention.Method: Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models.Results: For Trial 1, a cutoff of 0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia.Conclusions: The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of

Introduction: Cognitive efforts tests, such as the Test of Memory Malingering (TOMM), are widely used internationally, yet emerging research suggests that performance on the TOMM can be affected by...

Objective Temporal discounting describes the devaluation of delayed rewards. Because temporal discounting is predictive of substance misuse, its clinical assessment could improve prevention (e.g., identifying at-risk youth) and treatment (e.g., predicting relapse). However, if discounting rates can be faked (e.g., to avoid treatment), their clinical utility may be limited. For the first time, we measured the influence of deception in a temporal discounting task. Method We recruited 200 participants (44% female, M age = 33) through Amazon Mechanical Turk. Participants completed a discounting assessment with instructions to (a) respond honestly, (b) fake good (i.e., simulate better versions of themselves), or (c) fake bad. Results Generalized linear mixed effects analysis showed that in Experiment 1, nonclinical samples faked good ( M hyperbolic discounting rate = 0.002) or bad ( M = 0.086) compared to the Honest group ( M = 0.008). In Experiment 2, cigarette smokers faked good ( M = 0.003) compared to the Honest group ( M = 0.025). Conclusions Temporal discounting transects the disciplines of psychology, biology, and behavioral economics. Before its promise as an endophenotype can be realized, assessments must be translated for clinical use. Opaquer temporal discounting tasks, or secondary measures of lying, may be required before temporal discounting can be confidently extended to clinical settings.

The current project outlines the development of the Attention-Deficit/Hyperactivity Disorder (ADHD) Symptom Infrequency Scale (ASIS), a stand-alone measure designed to identify individuals feigning or exaggerating symptoms to receive a diagnosis of ADHD. Over the course of 3 studies, valid data was collected from 402 participants assigned to control, simulator, ADHD diagnosed, or possible undiagnosed ADHD groups. Group assignment was based on self-reported history of ADHD diagnosis including information about the credentials of diagnosing professional and methods used. The ASIS includes an Infrequency Scale (INF) designed to detect rarely reported symptoms of ADHD and several clinical scales designed to measure genuine symptoms. The final version of the ASIS demonstrated high internal consistency for the INF (α = .96) and the ADHD Total scales (α= .96). Convergent validity for the ADHD Total was established through a strong correlation with Barkley Adult ADHD Rating Scale-IV (r = .92). Initial validation of the INF yielded high discriminability between groups (d = 2.76; 95% confidence interval [2.17, 3.36]). The final INF scale demonstrated strong sensitivity (.79-.86) and excellent specificity (.89). Using our study's malingering base rate of 29%, positive and negative predictive values were strong (.71-.79 and .92-.93, respectively). Additional information is provided for a range of base rates. Current results suggest that the ASIS has potential as a reliable and valid measure of ADHD that is sensitive to malingering when compared to a sample of individuals self-reporting a history of ADHD diagnosis. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

There is increasing awareness of the need to use Performance Validity Tests (PVTs) when assessing cognitive abilities in children. Since 1996, there has been an ongoing clinical study of the use of three PVTs with a consecutive series of 1,285 developmentally disabled children. In this study, we report on the results of these PVTs in children of many diagnostic categories. Failure rates on all three tests were very low. The mean scores on the effort measures in those passing the PVTs were extremely high. Failure on each PVT was found to be associated with a significant and widespread suppression of scores across a neuropsychological battery. Failure on even one PVT significantly suppresses ability test scores.

Objective The purpose of this experimental pilot study was to evaluate whether distraction can affect results of performance validity testing. Method Thirty-three veterans who have served in the US military since 09/11/2001 (Mage = 38.60, SD = 10.85 years) completed the Test of Memory Malingering (TOMM), Trail Making Test, and Medical Symptom Validity Test (MSVT). Subjects were randomly assigned to complete the MSVT in one of three experimental conditions: standard administration, while performing serial 2 s (Cognitive Distraction), and while submerging a hand in ice water (Physical Distraction). Results All participants included in primary analyses passed the TOMM (n = 30). Physical distraction did not affect performance on the MSVT. Cognitive distraction negatively affected MSVT performance. Conclusions Cognitive distraction can substantially affect MSVT performance in a subgroup of individuals. Physical distraction did not significantly affect MSVT performance.

Objective The Personal Problems Questionnaire (PPQ) is a measure designed to assess acquired cognitive, emotional, and physical complaints. The present study sought to develop a normative database to allow clinicians and researchers to assess self-reported complaints among people with disabilities, and evaluate the response consistency and validity of their self-report. Method 404 community-dwelling participants (n 200 males, 204 females) completed the PPQ, as well as an acquired brain injury (ABI) group (n 59), mainly following stroke and traumatic brain injuries, and seen for clinical (i.e., non-forensic) evaluations. Multiple regression analyses were conducted to derive norms from the healthy community sample taking into account age, gender, and educational level. Results Normative T scores and cut-off points for the Clinical and Validity scales were derived, respectively, and used to assess the responses of the ABI group. The results indicated that the ABI group showed good response consistency and elevated scores on the Clinical scales, indicating that the PPQ is likely to be useful in detecting acquired disabilities. On the other hand, scores on the Validity scales were not elevated, indicating that the measures were unaffected by the ABI participants’ cognitive difficulties. Conclusions The PPQ provides a comprehensive assessment of complaints and response validity and the present study provides further data to assist with its use and interpretation.

Performance validity testing has developed into an indispensible element of neuropsychological assessment, mostly applied in forensic determinations. Its aim is to distinguish genuine patient performance from invalid test profiles. Limits to the applicability of performance validity tests (PVTs) may arise when genuine cognitive symptoms are present.We studied the robustness of four commonly used PVTs in a sample of 15 acute patients after cerebrovascular stroke, with first manifestations of aphasia. Severity of aphasia varied from very mild to severe. Subsequent neuroimaging revealed left-hemisphere infarction for all participants.The Test of Memory Malingering was the only measure found to be robust against effects of genuine language impairment (one positive on Trials 1 and 2, none on Trial 3), while unacceptable false-positive rates were found for the Fifteen-Item Test (60%) and two embedded measures, Reliable Spatial Span (40%) and Reliable Digit Span (73.3%). Four patients (26.7%) scored positive on at least three of the four PVTs.These data add to the ongoing discussion about the risk of false-positive classifications in genuine patient populations. Misdiagnosis with severe consequences for the patient in question may arise if results of PVTs are interpreted without concurrently considering the whole context of clinical evidence.

Although the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely studied and utilized screening measure with an Effort Index (EI), there is a minimal amount of data available regarding the utility of the EI for forensic inpatients. Specific concerns include the possibility that the published cutoffs would result in high false positive rates. The present study investigated this issue by comparing the validity of the RBANS EI with that of the Dot Counting Test (DCT) and Test of Memory Malingering (TOMM) in a forensic psychiatric setting (

Background We investigated a simple, novel diagnostic test for detecting incomplete effort during the motor portion of the neurological examination. Methods The results from the honest palm sign (HPS) were evaluated for 162 consecutive neuro-oncology patients who had undergone upper extremity strength testing. Deltoid, bicep, and wrist extensor strength was assessed in all patients. During the examination, patients were repeatedly encouraged to “try as hard as possible” and to “resist with all your strength.” The absence of nail prints on the palms constituted a positive HPS test result (i.e., indicative of incomplete effort). The presence of nail prints constituted a negative HPS test result (i.e., indicative of full effort). Results A total of 162 patients were tested. Their mean age was 55.5 ± 14.9 years, the median Karnofsky performance scale score was 80 (range, 60–100), and 63 patients (39%) were men. Of the 162 patients, 102 (63%) had malignant gliomas, 28 (17%) had brain metastases, 21 (13%) had other primary brain tumors, and 11 (6.8%) had primary central nervous system lymphomas. Of the 162 patients, 48 (30%) had positive HPS test results. The test sensitivity (84.6%), specificity (75.2%), positive likelihood ratio (3.41), and negative likelihood ratio (0.205) were good. After excluding 33 patients with characteristics that rendered them unsuitable for testing, the results from the remaining 129 patients were analyzed. The sensitivity was unchanged (84.6%), but the specificity (96.6%), positive likelihood ratio (24.5), and negative likelihood ratio (0.16) improved dramatically. Conclusions The HPS test is a simple, sensitive, and very specific test for detecting incomplete effort during the motor portion of neurological evaluations.

Malingering is commonly encountered in the psychiatric emergency department, yet little is known about its prevalence, objectives, or effect on patient management. This study analyzed characteristics of malingering and patient disposition in a 24/7-staffed comprehensive psychiatric emergency program (CPEP) and created predictive models to understand malingering and its effect on physician decision making.Attending psychiatrists completed questionnaires after comprehensive assessments of 405 patients presenting to the CPEP during the 1-month study, recording suspicion of malingering, symptoms malingered, associated secondary gains, demographic characteristics, and initial disposition decision. Analyses examined characteristics associated with degree of malingering suspicion and disposition.Malingering was suspected among one-third of patients, and 20% were strongly or definitely suspected of malingering. High suspicion was associated with malingering of multiple symptoms and was likely to result in immediate discharge. Lower suspicion was associated with being held for further observation. Among patients for whom suspicion of malingering was high, malingering was most frequent for suicidal ideation (58%) and depression (39%); malingering was often used to seek hospital admission (54%) and to stay in the CPEP (35%); malingering was sometimes used to seek multiple secondary gains (25%); and malingering often involved multiple symptoms (44%). Patients for whom suspicion was high had an admission rate of 4%. Among patients suspected of malingering, three variables each independently increased the likelihood of hospital admission: seeking social work or housing services, seeking admission, and malingering of suicidal ideation.Malingering was prevalent in the psychiatric emergency department, and suspicion of malingering was associated with disposition differences. Disposition was significantly influenced by both suspicion of malingering and the gains sought by patients.

The relationships between gender and malingering have received little attention in the literature. Our study examined data from 1,748 patients committed as incompetent to stand trial between 2008 and 2017, of whom 397 were women. Scores on a structured assessment of feigned psychiatric symptoms were only slightly higher for men than for women. Yet evaluators believed that over 23 percent of men but less than 15 percent of women were malingering. Our data suggest that these gender differences in rates of malingering may be attributable to symptom constellations and extent of criminal arrest history.

To examine clinical and sociodemographic differences between psychiatric patients suspected of malingering and non-malingering controls in an urban emergency department (ED) setting.We used retrospective chart review to compare 57 psychiatric patients suspected of malingering with 195 date-matched controls. We examined evidence used for malingering and documented secondary gains.The prevalence of malingering was 5.6-7.1%, with documented evidence consistent with DSM-V guidelines. Malingering patients were more likely to be male (p .001),45 years old (p = .002), Black (p = .049), unhoused (p .001), and frequent users of ED (p .001). Psychiatric diagnoses were found in ~75% of malingerers. Diagnosis of antisocial personality (OR = 8.03, p = .013) and substance use disorder (OR = 2.05, p = .018) predicted increased probability of malingering. Malingering encounters were more likely to result in discharges (p .001). The most common secondary gains were unmet clinical needs.Results support adaptational models of malingering. Malingering patients are more likely to have sociodemographic vulnerabilities. A disproportionate number of malingering patients have unmet needs for psychiatric treatment and resources. The study provides further evidence for inequities that may be related to social and structural determinants of health.

Background Individuals with dissociative identity disorder (DID) have complex symptoms consistent with severe traumatic reactions. Clinicians and forensic assessors are challenged by distinguishing symptom exaggeration and feigning from genuine symptoms among these individuals. This task may be aided by administering validity measures. Objective This study aimed to document how individuals with DID score on the Structured Inventory of Malingered Symptomatology (SIMS). The second objective was to compare coached DID simulators and healthy controls to DID patients on the SIMS’s total score and subscales. The third objective was to examine the utility rates of the SIMS in distinguishing simulated DID from clinically diagnosed DID. Method We compared SIMS data gathered from participants from two Dutch sites, one Swiss site and one U.S. site. Sixty-three DID patients were compared to 77 coached DID simulators and 64 healthy controls on the SIMS. A multivariate analysis compared the groups on the SIMS total scores and subscales, and post-hoc Games Howell tests and univariate ANOVAs examined differences between the groups. Utility statistics assessed the accuracy of the SIMS in distinguishing clinical from simulated DID. Results DID simulators scored significantly higher than DID individuals and healthy controls on every SIMS subscale as well as the total score. The majority (85.7%) of the individuals with DID scored above the cut-off, which is typically interpreted as indicative of possible symptom exaggeration. DID individuals scored higher than the healthy controls on every subscale except Low Intelligence, even after controlling for dissociation. The subscales and items most frequently endorsed by the DID group are consistent with symptoms associated with complex trauma exposure and dissociative reactions. The SIMS total score had a sensitivity of 96% but an unacceptably low specificity of 14%. Conclusions The findings indicate that the instrument is not accurate in assessing potential symptom exaggeration or feigning in DID., HIGHLIGHTS The malingering screen, Structured Inventory of Malingered Symptomatology (SIMS), cannot accurately distinguish SIMS data collected from DID patients compared to DID feigners.The items endorsed by the DIDs are consistent with symptoms associated with complex trauma exposure.

Mr. C is a 45-year-old male inmate who was found in his cell unresponsive and mute. He had poor food and fluid intake for the last four days and was later found standing in place, frozen, and resistant to movement when encouraged by a corrections officer to rest in his bed. His symptoms were consistent with catatonia, a severe motor syndrome that can be life-threatening. The patient had a psychiatric history of bipolar I disorder with multiple past episodes of catatonia. Lorazepam was ineffective at reversing his catatonic symptoms, and his serum creatinine kinase level eventually began to rise, suggestive of muscle breakdown and worsening severity. The treating psychiatrist wanted access to electroconvulsive therapy (ECT) to treat Mr. C's catatonia but encountered numerous legal and logistical barriers which made this treatment option unavailable. The article reviews the scant literature on ECT use in the adult U.S. correctional system, identifies barriers, and discusses a recommended ECT referral process for inmates.

[EN] The prevalence of malingering among individuals presenting whiplash-related symptoms is significant and leads to a huge economic loss due to fraudulent injury claims. Various strategies have been proposed to detect malingering and symptoms exaggeration. However, most of them have been not consistently validated and tested to determine their accuracy in detecting feigned whiplash. This study merges two different approaches to detect whiplash malingering (the mechanical approach and the qualitative analysis of the symptomatology) to obtain a malingering detection model based on a wider range of indices, both biomechanical and self-reported. A sample of 46 malingerers and 59 genuine clinical patients was tested using a kinematic test and a self-report questionnaire asking about the presence of rare and impossible symptoms. The collected measures were used to train and validate a linear discriminant analysis (LDA) classification model. Results showed that malingerers were discriminated from genuine clinical patients based on a greater proportion of rare symptoms vs. possible self-reported symptoms and slower but more repeatable neck motions in the biomechanical test. The fivefold cross-validation of the LDA model yielded an area under the curve (AUC) of 0.84, with a sensitivity of 77.8% and a specificity of 84.7%., Open access funding provided by Universita degli Studi di Padova within the CRUI-CARE Agreement. This work was supported by funding from the European Union's Horizon 2020 research and innovation program under grant agreement No 777090

Introduction The neuropsychological assessment is a cornerstone in the care management of concussion or mild traumatic injury. Objective To present the different stages of an exhaustive neuropsychological assessment exploring cognitive and behavioral domains. Method Description of the value of the main tests available for behavioral and cognitive assessment. The choice of tests is based on the clinical experience and expertise of the authors. Results Questionnaires are mainly used to explore the behavioral sequelae (depression, anxiety or fatigue) and the impact of these potential difficulties in daily life. Four cognitive abilities could be impaired by concussion: attention, memory, visuospatial functions and executive functions. These abilities could be explored with “paper and pencil” tests or with computerized test batteries. While cognitive sequelae in the context of a moderate or a severe traumatic brain injury are consolidated, in the context of concussion, neuropsychological sequelae tend to resolve in a short time. As a consequence, several neuropsychological assessments could be conducting in a short period involving some methodological considerations. Moreover, as concussion could be reported in a Whiplash injury from a car crash with forensic consequences, it is crucial to propose tests to be sure that the weak performance obtained into the neuropsychological assessment is not explained by poor effort and/or malingering. Discussion/conclusion This article revises these aspects of a neuropsychological assessment in the specific context of concussion.

The objective of this work is to evaluate the ability of a series of possible feigning indicators, extracted from relevant literature in the field, to discriminate between clinical patients with genuine symptomatology and instructed malingerers. A sample of 273 participants divided into two groups was used for this study: 153 whiplash associated disorder patients who were evaluated at a multidisciplinary medical center in the region of Murcia (Spain), between December 2017 and March 2019 and 120 healthy controls with malingering instructions, students of the Faculty of Medicine of the University of Murcia. In order for researchers to evaluate the indicators included in the study, a 22-step checklist (CDS) was developed, consisting of 22 criteria divided into 5 dimensions. Our results show that 18 of 22 indicators could discriminate between groups. Dimension 2 “Attitude toward the situation of illness” presented the greatest capacity for discrimination. In general terms, malingerers express a much more negative experience of the condition than the clinical patients.

We evaluated the classification accuracy of two abbreviated versions of the Test of Memory Malingering (TOMM) in prediction of results on the full-length instrument in a sample of 126 children who were evaluated within 1-12 months after traumatic brain injury. Both a version based on administration of Trial 1 and a version based on administration of only the first 10 items of Trial 1 had acceptable specificity (i.e.,.90) and sensitivity (i.e.,.60) with regard to prediction of pass/fail results on the complete TOMM. Failure on the TOMM suppressed performance on measures of processing speed that were otherwise sensitive to severity of traumatic brain injury. We conclude that these abbreviated versions of the TOMM can be used in clinical practice with children with traumatic brain injury, at the discretion of the neuropsychologist.

Malingering of ADHD symptoms is a potential means of nonmedical use of prescription stimulants (NMUPS). The Subtle ADHD Malingering Screener (SAMS) provides a potential avenue for identification of symptom malingering. However, no real world evidence of this scale has been published to date. The goal of this study was to examine patterns of use of stimulant prescriptions and to evaluate the ability of the SAMS to identify NMUPS. This study employed a cross-sectional observational design to administer an online, self-administered survey instrument in a convenience sample of college-enrolled young adults with a prescription for stimulant medications at a campus pharmacy. Respondents were asked about their prescription characteristics, nonmedical use and drug diversion behavior, along with ratings on the SAMS. Over 33% of respondents self-reported past-year NMUPS and 18% reported past-year drug diversion. Over 35% of respondents rated NMUPS as being slight or no risk and 55% were classified by the SAMS as likely to be malingering or exaggerating their symptoms. Individuals reporting past-year NMUPS or diversion consistently scored higher on the SAMS. The SAMS showed potential for future application in the pharmacy setting. Further research is needed to evaluate the relationship of SAMS to NMUPS or drug diversion. The results of this study also highlight several growing issues with the diagnosis and treatment of ADHD among young adults enrolled in college. Addressing perception of risk, social norms, and providing healthcare professionals with tools to prevent misdiagnosis is critical to the management of this issue.

Objective: This study was designed to examine the classification accuracy of verbal fluency (VF) measures as performance validity tests (PVT).Method: Student volunteers were assigned to the control...

Current standards of practice in neuropsychology advocate for including validity tests (PVTs). Abbreviating PVTs, such as the Test of Memory Malingering (TOMM), may help reduce overall evaluation time while maintaining diagnostic accuracy. TOMM Trial 1 performance (T1), as well as the number of errors within the first 10 items of Trial 1 (TOMMe10), have shown initial promise as abbreviated PVTs but require additional external cross-validation. This study sought to replicate findings from other mixed, diverse, clinical samples and provide further validation of abbreviated administrations of the TOMM. Data included 120 veterans who completed the TOMM and 3 criterion PVTs during clinical evaluation. In total, performance from 68% of the sample was classified as valid (52% met criteria for cognitive impairment), and performance from 32% of the sample was invalid. Group differences, diagnostic accuracy statistics, and receiver operating characteristic (ROC) curves were analyzed for relevant TOMM indices. There were large (η²p= .45-.66), significant differences between validity groups (p < .001) on TOMM T1 and TOMMe10, with lower TOMM T1 and higher TOMMe10 scores for participants with invalid performance. Using established cut-scores, sensitivities/specificities were: TOMMe10 ≥1 error: .84/.66; ≥2 errors: .74/.93; TOMM T1 ≤40: .82/.93. ROC curve analysis yielded significant areas under the curve for both TOMMe10 and T1 with respective optimal cut-scores of ≥2 errors (.74 sensitivity/.93 specificity) and ≤41 (.84 sensitivity/.91 specificity). TOMMe10 and T1 performances are minimally impacted by cognitive impairment. Although both evidenced robust psychometric properties, TOMM T1 continued to show greater accuracy than TOMMe10. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

This study examined the performance of children consecutively admitted to an inpatient psychiatric unit on the Test of Memory Malingering (TOMM) (aged 5–12; n = 96) and Automatized Sequences Task (...