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One major obstacle to the accurate diagnosis of ADHD in college students is malingering, although many symptom self-report measures used in the diagnostic process do not contain validity scales to identify feigners. The Infrequency Index (CII) for the Conners’ Adult ADHD Rating Scale–Self-Report: Long Version (CAARS-S: L) was developed in response to this concern, although further validation of this index is needed. Another topic of interest in ADHD malingering research is the increasing use of online assessments. However, little is known about how ADHD is malingered in an online format, particularly on the CAARS-S: L. The current study utilized a coached simulation design to examine the feigning detection accuracy of the CII and provide initial results on the effect of administration format (paper vs. online) on CAARS-S: L profiles. Data from 139 students were analyzed. Students with ADHD and students instructed to feign the disorder produced statistically comparable elevations on seven of eight CAARS-S: L clinical scales. Clinical scale elevations were generally comparable between paper and online forms, although some differences in the clinical and simulated ADHD groups suggest the need for further research. The CII demonstrated modest sensitivity (0.36) and adequate specificity (0.85) at the recommended cut score across administration formats. Specificity reached desirable levels (>= .90) at a raised cut score. These values were similar across administration formats. Results support the use of the CII and online CAARS-S: L form

College students without ADHD may feign symptoms of ADHD to gain access to stimulant medications and academic accommodations. Unfortunately, research has shown that it can be difficult to discriminate malingered from genuine ADHD symptomatology, especially when evaluations are based only on self-report questionnaires. The present study investigated whether nonclinical college students given no additional information could feign ADHD as successfully as those who were coached on symptoms of the disorder. Similar to Jasinski et al. (2011) and other research on feigned ADHD, a battery of neuropsychological, performance validity, and self-report tests was administered. Undergraduates with no history of ADHD or other psychiatric disorders were randomly assigned to 1 of 2 simulator groups: a coached group that was given information about ADHD symptoms, or a noncoached group that was given no such information. Both simulator groups were asked to feign ADHD. Their performance was compared to a genuine ADHD group and a nonclinical group asked to respond honestly. Self-report, neuropsychological, and performance validity test data are discussed in the context of the effect of coaching and its implications for ADHD evaluations. Symptom coaching did not have a significant effect on feigning success. Performance validity tests were moderately effective at detecting feigned ADHD. (PsycINFO Database Record

Recent concern about malingered self-report of symptoms of attention-deficit hyperactivity disorder (ADHD) in college students has resulted in an urgent need for scales that can detect feigning of this disorder. The present study provided further validation data for a recently developed validity scale for the Conners' Adult ADHD Rating Scale (CAARS), the CAARS Infrequency Index (CII), as well as for the Inconsistency Index (INC). The sample included 139 undergraduate students: 21 individuals with diagnoses of ADHD, 29 individuals responding honestly, 54 individuals responding randomly (full or half), and 35 individuals instructed to feign. Overall, the INC showed moderate sensitivity to random responding (.44-.63) and fairly high specificity to ADHD (.86-.91). The CII demonstrated modest sensitivity to feigning (.31-.46) and excellent specificity to ADHD (.91-.95). Sequential application of validity scales had correct classification rates of honest (93.1%), ADHD (81.0%), feigning (57.1%), half random (42.3%), and full random (92.9%). The present study suggests that the CII is modestly sensitive (true positive rate) to feigned ADHD symptoms, and highly specific (true negative rate) to ADHD. Additionally, this study highlights the utility of applying the CAARS validity scales in a sequential manner for identifying feigning. (PsycINFO Database Record

This meta-analysis compares stand-alone and embedded performance and symptom validity tests (PVTs and SVTs) for attention-deficit/hyperactivity disorder (ADHD) malingering detection in college students. Simulation design studies utilizing college student samples were included (k = 11). Analyses consisted of measures designed or previously used for malingering detection. Random-effects models were constructed to provide aggregated weighted effect sizes (Hedges' g), indicating the difference between genuine ADHD and simulation groups. Overall PVTs (stand-alone and embedded) produced a large effect size (g = 0.84, 95% confidence interval [CI; 0.72, 1.13], p < .001), whereas overall SVTs (stand-alone and embedded) produced a medium-effect size (g = 0.54, 95% CI [0.44, 0.65], p < .001). Stand-alone PVTs (g = 0.98, 95% CI [0.84, 1.12], p < .001) outperformed embedded PVTs (g = 0.66, 95% CI [0.51, 0.80], p < .001). The stand-alone SVT (g = 0.66) and embedded SVTs (g = 0.54, 95% CI [0.43, 0.65], p < .001) produced medium-effect sizes. These findings support stand-alone PVTs and suggest that performance-based measures should be included in ADHD evaluation batteries, which may consist solely of symptom self-report measures. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Sports concussions are recognized as significant injuries among young athletes. Research demonstrates that return-to-play prior to becoming asymptomatic has significant repercussions including sustained cognitive deficits. Many programs have begun to use computerized testing rather than traditional neuropsychological tests to (a) determine baseline performance, (b) track symptoms, and (c) measure symptoms following concussion. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is one such tool. The current study examined ImPACT's convergent and discriminant validity by comparing scores from sports-related concussion athletes (SRC) to those from nonconcussed controls (CTL). SRC included 29 athletes, ages 12-16, referred for neuropsychological assessment following sports-related concussions. CTL included 25 healthy athletes, ages 12-16, who were concussion-free in the past year. Overall, results showed general support for ImPACT, when used to screen cognition. In fact, all ImPACT domains successfully differentiated between SRC and CTL athletes. Evidence supporting appropriate convergent validity was best for the Visual Memory domain. Further, ImPACT domains demonstrated variable discriminant validity. Overall examination of validity demonstrated that ImPACT has some weaknesses but may have utility in detecting postconcussion cognitive impairment.

Psychologists often use the Minnesota Multiphasic Personality Inventory (MMPI) and, more recently, its successor, the MMPI-2, to assess personality and psychological disturbances following traumatic brain injury (TBI). The present meta-analysis examined the pattern of mean Hedges’ d values on MMPI-2 validity (L, F, K) and clinical (1–4, 6–0) scales in individuals with TBI. Database keyword searches yielded ten studies providing post-TBI MMPI-2 profiles. Studies were required to include a pure TBI sample, individuals who were ≥18 at injury, and means and standard deviations for most MMPI-2 clinical scales. Analyses showed large effects for MMPI-2 scales F, 1, 2, 3, 7, and 8. Using Q statistics, moderating effects were found for TBI severity on scale 7 and for compensation-seeking/litigation status on scales 1, 2, 3, and 7. No significant effects were found for time post-injury. The available information was insufficient to examine the effect of lesion location, pre-injury personality and psychopathology, or time post-injury for samples with differing injury severities on MMPI-2 profiles. Results suggest that individuals with TBI report significant levels of psychopathology that may be moderated by TBI severity and compensation-seeking/litigation status. Discussion includes a literature critique given the meta-analytic findings and implications for future study of personality following TBI.

Parkinson's disease (PD) is a common, degenerative disorder of the central nervous system. Individuals experience predominantly extrapyramidal symptoms including resting tremor, rigidity, bradykinesia, gait abnormalities, cognitive impairment, depression, and neurobehavioral concerns. Cognitive impairments associated with PD are diverse, including difficulty with attention, processing speed, executive functioning, memory recall, visuospatial functions, word-retrieval, and naming. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) is FDA approved and has been shown to be effective in reducing motor symptoms of PD. Studies have found that stimulating STN and GPi are equally effective at improving motor symptoms and dyskinesias; however, there has been discrepancy as to whether the cognitive, behavioral, and mood symptoms are affected differently between the two targets. The present study used random-effects meta-analytic models along with a novel p-curve analytic procedure to compare the potential cognitive and emotional impairments associated with STN-DBS in the current literature to those associated with GPi-DBS. Forty-one articles were reviewed with an aggregated sample size of 1622 patients. Following STN-DBS, small declines were found in psychomotor speed, memory, attention, executive functions, and overall cognition; and moderate declines were found in both semantic and phonemic fluency. However, GPi-DBS resulted in fewer neurocognitive declines than STN-DBS (small declines in attention and small-moderate declines in verbal fluency). With regards to its effect on depression symptomatology, both GPi-DBS and STN-DBS resulted in lower levels of depressive symptoms post-surgery. From a neurocognitive standpoint, both GPi-DBS and STN-DBS produce subtle cognitive declines but appears to be relatively well tolerated.

Invalid self-report and invalid performance occur with high base rates in attention deficit/hyperactivity disorder (ADHD; Harrison, 2006; Musso & Gouvier, 2014). Although much research has focused on the development and validation of symptom validity tests (SVTs) and performance validity tests (PVTs) for psychiatric and neurological presentations, less attention has been given to the use of SVTs and PVTs in ADHD evaluation. This introduction to the special section describes a series of studies examining the use of SVTs and PVTs in adult ADHD evaluation. We present the series of studies in the context of prior research on noncredible presentation and call for future research using improved research methods and with a focus on assessment issues specific to ADHD evaluation. (PsycINFO Database Record

Parkinson's disease (PD) is a neurodegenerative disorder involving the basal ganglia, resulting in motor and extra-motor deficits. These extra-motor deficits may be reflective of a self-regulatory deficit impacting patients' ability to regulate cognitive processes, thoughts, behaviors, and emotions. There is a need to further examine the prevalence and range of self-regulation (SR) and executive functioning (EF) impairments in PD. This study sought to do so in a sample of patients with PD ( N = 31) who underwent deep brain stimulation (DBS) surgery for motor symptom treatment. Patients completed measures indicative of SR and EF including neurocognitive tests, heart rate variability (HRV), and self-report questionnaires to examine these constructs in PD. The highest prevalence of impairments were observed for total impulse control disorder (ICD) symptoms (74%), depressive symptoms (48%), verbal fluency (phonemic: 39%; semantic: 36%), mental flexibility (32%), and self-reported SR impairments (Metacognition: 32%; Behavioral Regulation: 29%). Correlations among theoretically related constructs (i.e., SR, EF) were modest and variable; challenging the idea that SR is a unitary construct for which different domains depend on a common resource. In patients with PD post-DBS, higher resting HRV, thought to be indicative of better autonomic functioning, was linked to better EF in some instances but not others and not significantly associated with self-report SR. Overall, patients with PD exhibit various extra-motor deficits, ranging from subtle to severe. Health care professionals working with patients with PD should recognize the presence of extra-motor deficits, particularly ICDs, and obstacles that might arise from such impairments in patients' daily lives.

Since the early 2000s concern has increased that college students might feign ADHD in pursuit of academic accommodations and stimulant medication. In response, several studies have validated tests for use in differentiating feigned from genuine ADHD. Although results have generally been positive, relatively few publications have addressed the possible impact of the presence of psychological disorders comorbid with ADHD. Because ADHD is thought to have accompanying conditions at rates of 50% and higher, it is important to determine if the additional psychological disorders might compromise the accuracy of feigning detection measures. The present study extended the findings of Jasinski et al. (2011) to examine the efficacy of various measures in the context of feigned versus genuine ADHD with comorbid psychological disorders in undergraduate students. Two clinical groups (ADHD only and ADHD + comorbid psychological disorder) were contrasted with two non-clinical groups (normal controls answering honestly and normal participants feigning ADHD). Extending previous research to individuals with ADHD and either an anxiety or learning disorder, performance validity tests such as the Test of Memory Malingering (TOMM), the Letter Memory Test (LMT), and the Nonverbal Medical Symptom Validity Test (NV-MSVT) were effective in differentiating both ADHD groups from normal participants feigning ADHD. However, the Digit Memory Test (DMT) underperformed in this study, as did embedded validity indices from the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Woodcock Johnson Tests of Achievement-III (WJ-III).

Traumatic brain injury (TBI) is the leading cause of death and disability in children and adolescents in the U.S. This is a pilot study, which explores the discrimination of chronic TBI from normal controls using scalp EEG during a memory task. Tsallis entropies are computed for responses during an old-new memory recognition task. A support vector machine model is constructed to discriminate between normal and moderate/severe TBI individuals using Tsallis entropies as features. Numerical analyses of 30 records (15 normal and 15 TBI) show a maximum discrimination accuracy of 93% (p-value = 7.8557E-5) using four features. These results suggest the potential of scalp EEG as an efficacious method for noninvasive diagnosis of TBI.

Recently there has been growing concern that college students may feign symptoms of ADHD in order to obtain academic accommodations and stimulant medication. Unfortunately research has only begun to validate detection tools for malingered ADHD. The present study cross-validated the results of Sollman, Ranseen, and Berry (2010) on the efficacy of several symptom validity tests for detection of simulated ADHD among college students. Undergraduates with a history of diagnosed ADHD were randomly assigned either to respond honestly or exaggerate symptoms, and were compared to undergraduates with no history of ADHD or other psychiatric disorders who were also randomly assigned to respond honestly or feign symptoms of ADHD. Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD. When considered as a group, the criterion of failure of 2 or more of these SVTs had a sensitivity of. 475 and a specificity of 1.00.

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

The MMPI and MMPI-2 validity scales have long been accepted as standard tools in the assessment of feigned mental disorders (FMD) based on their extensive empirical validation. Studies are now examining MMPI-2-RF with modified validity scales plus the new Infrequent Somatic Responses Scale (FS) and the recently-adapted Response Bias Scale (RBS). The current investigation used a known-groups design to examine the effectiveness of the MMPI-2-RF for differentiating FMD and feigned cognitive impairment (FCI) from patients with genuine disorders for a large civil forensic sample. Criterion measures included the Structured Interview of Reported Symptoms-2 (SIRS-2) for the FMD group, and below-chance performances on the Victoria Symptom Validity Test (VSVT) and the Test of Memory Malingering (TOMM) for the FCI group. For FMD, both F-r and FP-r produced very large effect sizes (ds > 2.00). Moreover, the absence of severe elevations (≥80 T) on F-r proved effective at ruling-out most FMD. For the current study, a FP-r cut score ≥90 T for FMD produced virtually no false-positives (0.01) and only a moderate level of false-alarms. As predicted by its detection strategies, most MMPI-2-RF validity scales have limited effectiveness with the FCI group. However, FBS-r and RBS may be useful in conjunction with other clinical data for ruling out FCI for genuine neuropsychological consults. An entirely separate concern is whether certain diagnostic groups, such as major depression, will have marked elevations on MMPI-2-RF scales thereby increasing the likelihood of false-positives. On this point, FP-r performed exceptionally well with unelevated scores (Ms < 55 T) consistently across diagnostic categories.

Twenty-four studies utilizing the Wechsler Adult Intelligence Scale (WAIS) Digit Span subtest--either the Reliable Digit Span (RDS) or Age-Corrected Scaled Score (DS-ACSS) variant--for malingering detection were meta-analytically reviewed to evaluate their effectiveness in detecting malingered neurocognitive dysfunction. RDS and DS-ACSS effectively discriminated between honest responders and dissimulators, with average weighted effect sizes of 1.34 and 1.08, respectively. No significant differences were found between RDS and DS-ACSS. Similarly, no differences were found between the Digit Span subtest from the WAIS or Wechsler Memory Scale (WMS). Strong specificity and moderate sensitivity were observed, and optimal cutting scores are recommended.

This study examined the utility of the Minnesota Multiphasic Personality Inventory—2 Restructured Form (MMPI-2-RF) validity scales for detecting feigning and exaggeration of attention-deficit/hyperactive disorder (ADHD) among college students. Under a simulation study design, participants with and without ADHD were assigned to perform honestly or to feign or exaggerate deficits related to ADHD while completing self-report symptom inventories. Participants instructed to feign produced symptom profiles similar to honest clinical profiles and more severe than honest nonclinical profiles. Participants with ADHD instructed to exaggerate produced less severe profiles than those instructed to feign and more severe profiles than clinical controls. MMPI-2-RF scale Fp-r showed potential for use in malingered ADHD detection at a revised cut score, which was significantly lower than the cut score suggested in the test manual; use of the revised cut score will require further validation. Scales F-r, Fs, and FBS-r did not classify well, but should be assessed in future studies of malingered ADHD. Detection of exaggeration was consistently poorer than detection of feigning.

The DSM criteria for identifying malingering are reviewed and found to be flawed on both conceptual and practical grounds. Alternative models for diagnosing feigned psychiatric, physical, and neuropsychological symptoms are presented. A number of useful features of these systems are highlighted for potential contributions to modified DSM criteria. It is recommended that the present DSM text on malingering be replaced with feigned psychiatric, physical, or neuropsychological symptoms and suggestions for developing criteria for this condition are made.

In a cross-validation of results from L. O. Graue et al. (2007), standard psychological assessment instruments, as well as tests of neurocognitive and psychiatric feigning, were administered under standard instructions to 24 participants diagnosed with mild mental retardation (MR) and 10 demographically matched community volunteers (CVH). A 2nd group of 25 community volunteers was instructed to malinger MR (CVM) during testing. CVM participants obtained Wechsler Adult Intelligence Scale (3rd ed.; D. Wechsler, 1997) Full Scale Intelligence Quotient scores that were significantly lower than the demographically similar CVH group but comparable to the MR group, suggesting that CVM subjects feigned cognitive impairment. On the basis of standard cutting scores from test manuals or published articles, of the 11 feigning measures administered, only the Test of Memory Malingering (TOMM; T. N. Tombaugh, 1996) retention trial had a specificity rate >.90 in the MR group. However, the 2nd learning trial of the TOMM, as well as a short form of the Digit Memory Test (T. J. Guilmette, K. J. Hart, A. J. Guiliano, & B. E. Leininger, 1994), approached this level of specificity, with both at .88. These results raise concerns about the specificity rates at recommended cutting scores of commonly used feigning tests in defendants with MR.

Significant motivations and incentives exist for young-adult students to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD). With ADHD information readily accessible on the Internet, today's students are likely to be symptom educated prior to evaluation. This may result in false-positive diagnoses, particularly when students are motivated to convey symptoms. We evaluated the utility of ADHD symptom checklists, neurocognitive tests, and measures initially developed to detect feigned neurocognitive or psychiatric dysfunction (symptom validity tests [SVTs]). The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale-Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test-II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal-Medical Symptom Validity Test), particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD.

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

A taxometric analysis of 3 factor scales extracted from the Health Problem Overstatement (HPO) scale of the Psychological Screening Inventory (PSI; R. I. Lanyon, 1970, 1978) was performed on the data from 1,240 forensic and psychiatric patients. Mean above minus below a cut, maximum covariance, and latent-mode factor analyses produced results indicative of dimensional latent structure for the exaggerated health complaints construct. The outcome of this and several other recent taxometric investigations indicates that across 3 different domains of feigning (i.e., psychiatric symptoms, memory problems, and health complaints), the overall feigning construct is ordered continuously along 1 or more dimensions rather than partitioned into discrete categories of malingerers and nonmalingerers. These findings call for more research on the extent to which the different domains of feigning share 1 or more dimensions in common.

The ability of the Test of Memory Malingering (TOMM), reaction times (RTs), and event-related potentials (ERPs) to detect malingered neurocognitive deficit (MNCD) was examined in 32 normal individuals answering under honest (HON; n = 16) or malingering (MAL; n = 16) instructions as well as in 15 patients with traumatic brain injury (TBI) who answered under honest instructions. Overall, the TOMM was the most effective at classifying groups. However, new accuracy, RT, and ERP measures reached promising hit rates in the range of 71-88%. In particular, the difference in frontal versus posterior ERP obtained during an old-new task was effective at classifying MAL versus TBI (hit rate = 87%).

A manual form of the Letter Memory Test (LMT: Orey, Cragar, & Berry, 2000) was compared in neuropsychological evaluees classified as honest (HON: n = 39) or probable cognitive feigners (PCF: n = 10) using results from two well-validated motivational tests. With the exception of lower educational level and higher rate of compensation seeking in the PCF, the groups were equivalent on most important demographic and injury severity parameters. PCF participants scored significantly lower on most neuropsychological tests (median Cohen's d = 1.2), as well as on the manual LMT (Cohen's d = 4.2). Operating characteristics of the manual LMT in the present sample were comparable to those reported in a similar study using the computerized version of the LMT in neuropsychiatric patients (Vagnini et al., 2006).

This study compared the effectiveness of the Structured Inventory of Malingered Symptoms (SIMS; Widows & Smith, 2005) and the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) at screening for feigned psychiatric and neurocognitive symptoms in 308 individuals undergoing neuropsychiatric evaluation for workers' compensation or personal injury claims. Evaluees were assigned to probable feigning or honest groups based on results from well-validated, independent procedures. Both tests showed statistically significant discrimination between probable feigning and honest groups. Additionally, both the M-FAST and SIMS had high sensitivity and negative predictive power when discriminating probable psychiatric feigning versus honest groups, suggesting effectiveness in screening for this condition. However, neither of the procedures was as effective when applied to probable neurocognitive feigners versus honest groups, suggesting caution in their use for this purpose.

A recent Supreme Court decision--Atkins v. Virginia, 536 U.S. 304 (2002)--prohibiting the execution of mentally retarded (MR) defendants may have raised the attractiveness of feigning this condition in the criminal justice system. Unfortunately, very few published studies have addressed the detection of feigned MR. The present report compared results from tests of intelligence, psychiatric feigning, and neurocognitive faking in a group of 26 mild MR participants (MR) and 25 demographically matched community volunteers asked to feign MR (CVM). Results showed that the CVM suppressed their IQ scores to approximate closely the level of MR participants. WAIS-III and psychiatric malingering measures were relatively ineffective at discriminating feigned from genuine MR. Although neurocognitive malingering tests were more accurate, their reduced specificity in MR participants was of potential concern. Revised cutting scores, set to maintain a Specificity rate of about .95 in MR clients, were identified, although they require cross-validation. Overall, these results suggest that new cutting scores will likely need to be validated to detect feigned MR using current malingering instruments.

Twenty subjects referred to a sleep laboratory for evaluation of sleep apnoea and found not to have any sleep disordered breathing problems were evaluated in this study. Bruxing events were recorded for frequency, duration, association with sleep stage and sleep position. The possible association between leg movements and bruxing events was also evaluated, but did not reveal any common mechanism. This study revealed that heart rate during bruxing events increased on average by 16.6%.

United States veterans of the Iraqi (Operation Iraqi Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in post-traumatic stress disorder (PTSD). A large number of returning service members have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/OEF veterans to determine whether participants with a history of mTBI and current PTSD (mTBI+PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or veteran controls (VC), when groups are comparable on intelligence quotient, education, and age. The mTBI+PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI+PTSD on the same variables. Additionally, the mTBI+PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest that veterans with mTBI+PTSD perform significantly lower on neuropsychological and psychiatric measures than veterans with mTBI-o or PTSD-o. The results also raise the possibility of mild but persisting cognitive changes following mTBI sustained during deployment.

Exaggeration of cognitive symptoms or poor effort on cognitive testing has been addressed primarily in the traumatic brain injury literature. The present investigation aims to extend the evaluation of effort to the epilepsy monitoring setting, where base rates of failure on effort testing remain unknown for patients with intractable epilepsy (ES), psychogenic nonepileptic seizures (PNES), or both conditions (ES+PNES). In addition, this investigation explores how well four measures of effort (DMT, LMT, TOMM, PDRT) distinguish between these diagnostic groups. Results show that 20% of the combined sample failed one or more effort measure. When examining failure rates for each diagnostic group, 22% of epilepsy patients, 24% of PNES patients, and 11% of ES+PNES patients performed suboptimally on one or more measure of effort. The utility of these effort measures to differentiate between these diagnostic groups appears limited. Further research is needed to clarify the base rate of poor effort in the epilepsy monitoring unit setting in general and in these three diagnostic groups specifically.

Previous research suggests epilepsy and psychogenic non-epileptic seizure (PNES) patients do not show consistent group differences on neuropsychological measures. However, both groups of patients show decreased neuropsychological performance when compared to a normal population (Cragar, Berry, Fakhoury, Cibula, & Schmitt, 2002). Swanson, Springer, Benbadis, and Morris (2000) have suggested epilepsy patients show decreased neurocognitive functioning due to neuropathology whereas PNES patients show decreased neurocognitive functioning due to psychopathology. Effort has also been implicated as an important factor in neuropsychological test results in general (Green, 2003). The purpose of this study was to investigate the relationships of medical history variables (e.g., duration of disorder), neuropathology, psychopathology, and effort to neuropsychological findings in epilepsy and PNES patients. Neuropsychological functioning was divided into six domains: intelligence, memory, language, executive functions, visual-spatial, and motor. Results indicated that medical history variables were related to intellectual, memory, language, and motor functioning. Psychopathology was associated with all cognitive domains except executive functioning. Effort was related to intellectual, memory, language, visual-spatial, and motor functioning. Neuropathology and diagnosis were related only to memory.

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

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

A number of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) items have been hypothesized to reflect neurologic symptomatology, rather than psychopathology, among closed-head-injury (CHI) patients. Some investigators have proposed a correction factor interpretive approach, which involves the deletion of such items from the MMPI-2 profile, as a method of reducing the probability of artificial clinical scale elevations due to the symptoms of CHI. The present study employed receiver operating characteristic (ROC) analysis to evaluate the sensitivity and specificity of three correction factors. All three factors demonstrated strong sensitivity when discriminating CHI patients from normal individuals but demonstrated poor specificity when discriminating CHI patients from psychiatric patients. These findings suggest that caution should be applied in using MMPI-2 neurologic correction factors, particularly with patients who might have comorbid psychiatric conditions.

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

The diagnosis of psychogenic nonepileptic seizures (PNES) is complex. Long-term electroencephalogram monitoring with video recording (video EEG) is the most common method of differential diagnosis of epilepsy and PNES. However, video EEG is complex, costly, and unavailable in some areas. Thus, alternative diagnostic techniques have been studied in the search for a diagnostic method that is as accurate as video EEG, but more cost effective, convenient, and readily available. This paper reviews the literature regarding possible diagnostic alternatives and organizes findings into 7 areas of study: demographic and medical history variables, seizure semiology, provocative testing, prolactin levels, single photon emission computed tomography, psychological testing, and neuropsychological testing. For each area, the literature is summarized, and conclusions about the accuracy of the technique as a diagnostic tool are drawn. Overall, it appears unlikely that any of the reviewed alternative techniques will replace video EEG monitoring; rather they may be more successful as complementary diagnostic tools. An important focus for further investigations involves combinations of diagnostic techniques for the differential diagnosis of epilepsy and PNES.

We investigated the research validity scales for the NEO Personality Inventory-Revised (NEO-PI-R) proposed by Schinka, Kinder, and Kremer (1997): Positive Presentation Management (PPM) and Negative Presentation Management (NPM). Additionally, an experimental analog to the Minnesota Multiphasic Personality Inventory-2's (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) F - K index was calculated by subtracting the raw score on PPM from the raw score on NPM (NPM - PPM). In 2 studies, all indexes showed significant between-group differences when samples of analog malingerers (n = 97) were contrasted with psychiatric outpatients (n = 272). The sensitivity and specificity of these validity indexes indicated that although none performed well in extremely low base rate environments, the NPM and NPM - PPM indexes showed promise when the base rate of faking bad rose to higher levels.

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) results were compared in 118 psychiatric outpatients given standard instructions, instructions to exaggerate their problems, instructions to feign a disorder they did not have, or instructions to feign global psychological disturbance. The groups were comparable on demographic, occupational and diagnostic characteristics as well as intake MMPI-2 results. Experimental MMPI-2 results showed that clinical scales were generally elevated in the feigning groups, with only modest differences across dissimulating instruction sets. The feigning groups had reliably higher scores than controls on all overreporting indexes examined, although no significant differences between feigning groups were present for overreporting indexes. Classification rates using previously proposed cutting scores for outpatients on individual feigning indexes showed near perfect specificity, but low to at best moderate sensitivity. Multiple regression analyses indicated that Gough's (1954) Dissimulation Scale (Ds2) was most strongly related to feigning status, and no other feigning scale contributed a significant increment in predictive power once Ds2 was entered.

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

The NEO Personality Inventory-Revised (NEO PI-R; Costa & McCrae, 1992) is the updated version of the NEO PI (Costa & McCrae, 1985). The NEO PI-R is a widely used measure of the Five Factor Model (FFM) of adult personality, covering the domains of Neuroticism, Openness to Experience, Extraversion, Agreeableness, and Conscientiousness. The FFM is a robust model of normal personality, with a factor structure that has been replicated across many languages and cultures (McCrae et al., 2005). Information on these factors can be useful for understanding emotional, interpersonal, attitudinal, and motivational characteristics that are important for a variety of applications, including psychotherapy, counseling, and employment decisions. The NEO PI-R has also become a major research tool for examining the relationship between personality and behavioral, physical, and mental health variables. It is not intended, however, to assess overt or severe psychopathology, and it is not necessarily diagnostic of any specific psychiatric disorder found in the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000). Keywords: five factor model; personality assessment; personality research

Validity scales indicate the extent to which the results of a self-report inventory are a valid indicator of the test taker's psychological functioning. Validity scales generally are designed to detect the common response sets of positive impression management (underreporting, or faking good), negative impression management (overreporting, or faking bad), and random responding. The revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992b) is a popular personality assessment tool based on the 5-factor model of personality and is used in a variety of settings. The NEO-PI-R does not include objective validity scales to screen for positive or negative impression management. The purpose of this study was to examine the utility of recently proposed validity scales for detecting these response sets on the NEO-PI-R (Schinka, Kinder, & Kremer, 1997) and to examine the effects of positive and negative impression management on correlations between the NEO-PI-R and external criteria (the Interpersonal Adjective Scale-Revised-B5 [Wiggins & Trapnell, 1997] and the NEO-PI-R Form R). The validity scales discriminated with reasonable accuracy between standard responding and the 2 response sets. Additionally, most correlations between the NEO-PI-R and external criteria were significantly lower when participants were dissimulating than when responding to standard instructions. It appears that response sets of positive and negative impression management may pose a significant threat to the external validity of the NEO-PI-R and that validity scales for their detection might be a useful addition to the inventory.

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

Two previous meta-analyses concluded that average validity coefficients for the Rorschach and the MMPI have similar magnitudes (L. Atkinson, 1986; K. C. H. Parker, R. K. Hanson, & J. Hunsley, 1988), but methodological problems in both meta-analyses may have impeded acceptance of these results (H. N. Garb, C. M. Florio, & W. M. Grove, 1998). We conducted a new meta-analysis comparing criterionrelated validity evidence for the Rorschach and the MMPI. The unweighted mean validity coefficients (rs) were .30 for MMPI and .29 for Rorschach, and they were not reliably different (p = .76 under fixed-effects model, p = .89 under random-effects model). The MMPI had larger validity coefficients than the Rorschach for studies using psychiatric diagnoses and self-report measures as criterion variables, whereas the Rorschach had larger validity coefficients than the MMPI for studies using objective criterion variables.

The paper reviews the systems movement and suggests that systems engineering is required for successful problem solving and the redesign of manufacturing systems. A case study is outlined to indicate the application of systems engineering in manufacturing systems analysis. The urgent requirement for a new management team to gain insight into internal manufacturing processes and perceived problems provided a major driving force behind the project. The analysis revealed that the perceived problem of lack of automated handling within the assembly area was just one factor leading to poor manufacturing performance. System complexity and a lack of internal systems integration was highlighted; attributable to a number of causes categorised as organisational and attitudinal as well as technological.

The authors report on results from a new procedure for evaluating adequacy of effort given during neuropsychological testing. The letter memory test (LMT) is a computer-administered, 45-item, forced-choice recognition task that uses consonant letters as stimuli and manipulates face difficulty level along 2 dimensions: number of letters to be remembered and number of choices amongst which the target stimulus must be identified. In 3 studies that included either analogue or known groups designs, the LMT discriminated poorly motivated from well-motivated groups at a moderately high level of accuracy, which was comparable to that of the Digit Memory Test and superior to that of the 21-Item Test. The internal consistency reliability of the LMT was also high.

In clinical practice, the second edition of the Minnesota Multiphasic Personality Inventory (MMPI-2) validity indices are used to identify and subsequently exclude from interpretation protocols that include random responding. However, given that the items that comprise the clinical scales all fall within the first 370 items of the MMPI-2, if the onset of random responding occurs after item 370, then the clinical scales may be interpretable. The present report examines the utility of the standard and alternative MMPI-2 validity indices for detecting random responding within the first 370 items. Results suggested that all validity indices studied differed significantly between Interpretable and Uninterpretable protocols; however the Infrequency scale ( F), the alternative index F + Fb + | F − Fb|, and the Blocked Infrequency index (the number of 100 item MMPI-2 blocks with significant endorsements of F and Fb items equal to or exceeding 27%) provided for the highest hit rates across examined base rates of random responding. In addition, the proposed Variable Response Inconsistency-Front index ( VRINf) also provided for highly accurate classification rates and had specific advantages, including the scale's probable insensitivity to overreporting. Despite the promising nature of these findings, caution is encouraged in using MMPI-2 validity scales in this manner until these findings are cross-validated.

The Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) validity scales were evaluated to determine accuracy when differentiating honest responding, random responding, genuine posttraumatic stress disorder (PTSD), and feigned PTSD. Undergraduate students (n = 109), screened for PTSD, were randomly assigned to 1 of 4 instructional groups: honest, feign PTSD, half random, and full random. Archival data provided clinical MMPI-2-RF profiles consisting of 31 veterans diagnosed with PTSD. Veterans were diagnosed with PTSD using a structured interview and had passed a structured interview for malingering. Validity scales working as a group had correct classification rates of honest (96.6%), full random (88.9%), genuine PTSD (80.7%), fake PTSD (73.1%), and half random (44.4%). Results were fairly supportive of the scales' ability to discriminate feigning and full random responding from honest responding of normal students as well as veterans with PTSD. However, the RF validity scales do not appear to be as effective in detecting partially random responding.

Current combat veterans are exposed to many incidents that may result in mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). While there is literature on the neuropsychological consequences of PTSD only (PTSD-o) and mTBI alone (mTBI-o), less has been done to explore their combined (mTBI+PTSD) effect. The goal of this study was to determine whether Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans with mTBI+PTSD have poorer cognitive and psychological outcomes than veterans with PTSD-o, mTBI-o, or combat exposure-only. The final sample included 20 OIF/OEF veterans with histories of self-reported deployment mTBI (mTBI-o), 19 with current PTSD (PTSD-o), 21 with PTSD and self-reported mTBI (mTBI+PTSD), and 21 combat controls (CC) (no PTSD and no reported mTBI). Groups were formed using structured interviews for mTBI and PTSD. All participants underwent comprehensive neuropsychological testing, including neurocognitive and psychiatric feigning tests. Results of cognitive tests revealed significant differences in performance in the mTBI+PTSD and PTSD-o groups relative to mTBI-o and CC. Consistent with previous PTSD literature, significant differences were found on executive (switching) tasks, verbal fluency, and verbal memory. Effect sizes tended to be large in both groups with PTSD. Thus, PTSD seems to be an important variable affecting neuropsychological profiles in the post-deployment time period. Consistent with literature on civilian mTBI, the current study did not find evidence that combat-related mTBI in and of itself contributes to objective cognitive impairment in the late stage of injury.

The frequency of sleep-disordered breathing (SDB) events increases dramatically with age, although the clinical significance of this phenomenon is uncertain. We report herein on data from the fifth follow-up observation of a cohort of healthy elderly which we selected, evaluated, and followed up in an effort to address this issue. Baseline observations on this group of 95 normal older persons medically screened for good health included standard nocturnal polysomnograms and daytime assessment of medical, sleep/wake, and psychological variables. At fifth-year follow-up, 42 subjects returned for assessment. Comparison of returning vs nonretuming subjects indicated no significant differences in baseline characteristics between these groups. Division of returning subjects into moderate (apnea-hypopnea index [AHI] ≥5) vs low (AHI