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This study examined the utility of a screening battery developed by Reitan & Wolfson, 2006 for predicting neuropsychological impairment on the Halstead–Reitan neuropsychological test battery for adults. Using archival neuropsychological data from 69 litigants seen in a private practice setting, the Pearson correlation between the General Neuropsychological Deficit Scale (GNDS) score and the total Neuropsychological Deficit Scale (NDS) score from the screening battery (SBNDS) was .82. ROC curve analysis determined that the AUC was .88. Using a cutoff score of 9, as recommended by Reitan and Wolfson, the screening battery had excellent specificity but only fair sensitivity for identifying individuals with neuropsychological impairment on the Halstead–Reitan battery. Using a cutoff score of 8, the sensitivity and specificity of the screening battery was comparable to the findings of Reitan and Wolfson. The findings from this study indicate the optimal cutoff score for the screening battery may vary with different populations. The positive predictive power (PPP) and negative predictive power (NPP) were calculated for various base rates for cut scores with both sensitivity and specificity of greater than .600, and this information is provided.

Assessing effort level during neuropsychological evaluations is critical to support the accuracy of cognitive test scores. Many instruments are designed to measure effort, yet they are not routinely administered in neuropsychological assessments. The Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) are commonly administered symptom validity tests with sound psychometric properties. This study examines the use of the TOMM Trial 1 and the WMT Immediate Recognition (IR) trial scores as brief screening tools for insufficient effort through an archival analysis of a combined sample of mild head-injury litigants ( N = 105) who were assessed in forensic private practices. Results show that both demonstrate impressive diagnostic accuracy and calculations of positive and negative predictive power are presented for a range of base rates. These results support the utility of Trial 1 of the TOMM and the WMT IR trial as screening methods for the assessment of insufficient effort in neuropsychological assessments.

The practice of forensic neuropsychology can lead to many potential ethical dilemmas, including the request that a third party observer be present during an examination. Following a case example, we review relevant Ethical Standards from the recent revision of the American Psychological Association's Ethics Code (APA, 2002), as well as policy statements by the National Academy of Neuropsychology (NAN, 2000) and the American Academy of Clinical Neuropsychology (AACN, 2001) that should be considered when confronted with the request for observation by a third party. As many ethical dilemmas are rarely clear-cut, their answers will likely generate additional questions for the individual practitioner and the profession. Finally, we provide some suggested courses of action when presented with similar requests.

The increased role of neuropsychologists in the courtroom has led to an increased effort in the detection of possible symptom exaggeration/malingering. Whereas domain specific measures of malingering have traditionally been used in this detection process, the identification of performance profiles and cut-off scores on standard neuropsychological assessment instruments may provide an alternate strategy. The present study evaluated the effectiveness of performance profiles and cut-off scores in discriminating traumatic brain injury (TBI) litigants suspected of malingering from those not suspected of malingering on the Memory Assessment Scales (MAS). Results suggest that TBI litigants suspected of poor effort will perform globally at a lower level than TBI litigants not suspected of poor effort on nearly all MAS indices, however, the performance profiles of each group was similar. Cut-off scores, especially when used in combination, were also effective in correctly classifying individuals in the two groups. The present findings warrant further research examining the utility of the proposed cut-off scores separately and concomitantly. Such research will aid the clinical neuropsychological practitioner in interpreting aberrant performance profiles on the MAS in forensic situations.

At the request of the membership, and at the direction of the President, Dr. Barbara Uzzell, and the Board of Directors (BoD), the National Academy of Neuropsychology (NAN) Policy and Planning Committee has developed the following 2001 Definition of a Clinical Neuropsychologist, as part of NAN’s White Paper series on Professional Policy and Practice. The entire NAN membership has had an opportunity for input to this definition, and it has been clearly endorsed by our membership and the BoD. We believe that the 2001 NAN Definition incorporates the best aspects of the previous work on Definitions of a Clinical Neuropsychologist, if one keeps in mind that the intent is to provide information to managed care and third party payers regarding general neuropsychological practice and minimal educational, experiential, and licensure requirements. An inclusive, expanded, and updated definition referencing the 1989 and 1984 definition articles, published by Division 40 (Clinical Neuropsychology) of the American Psychological Association (APA) was considered necessary as an internal NAN reference document. This 2001 NAN Definition of a Clinical Neuropsychologist underwent three major Policy and Planning Committee revisions, one full membership review and one membership vote (81% endorsement out of 789 votes), and two NAN BoD comprehensive discussions, resulting in unanimous approval by a formal vote of the Board of Directors on May 5, 2001.

The importance of the detection of possible symptom exaggeration/malingering has gained increased attention among neuropsychologists, and as a result, a number of techniques have been developed for the identification of suspected malingering. The goal of this study was to examine the extent towhich several of these commonly used techniques correlate with one another in a clinical sample. Archival data on 97 litigants were analyzed, and scores on the Test of Memory Malingering (TOMM), Rey 15-Item Test (Rey-15), and MMPI-2 validity scales were compared. The MMPI-2 validity scales did not positively correlate with any trial on the TOMM or with the Rey-15, with the exception of the Fb scale which significantly negatively correlated with TOMM trial 1. The results of the present study suggest that the MMPI-2 validity scales are measuring a different construct than tests of malingered memory deficits, and therefore should be interpreted cautiously in forensic evaluations.

The Trail Making Test (TMT) is one of the most commonly administered tests in neuropsychological assessments. It has been shown to be a valid indicator of brain damage due to traumatic brain injury (TBI), as well as a number of other neuropathological conditions. TMT error and ratio scores have been suggested as possible markers of malingering. The present study examined the utility of various TMT scores as malingering measures in 94 TBI litigants. Litigants were divided into those suspected of (n = 27) and those not suspected of malingering (n = 67) based on scores obtained on the Test of Memory Malingering and/or the Rey 15-Item Test. TMT errors did not discriminate between suspected and nonsuspected malingerers; however, the overall level of performance on the TMT was suppressed in suspected malingerers. The TMT ratio score was significantly lower in litigants suspected of malingering, although the clinical utility of this ratio is minimal. Results of the present study suggest using caution when interpreting TMT scores as markers of malingering in TBI litigants.

State and federal laws and court decisions that address requests for the presence or absence of third party observers during forensic evaluations are reviewed, as are the legal arguments for both their inclusion and exclusion. Potential sources of interference created by observer's presence during the neuropsychological evaluation are outlined with reference to the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association, the Specialty Guidelines for Forensic Psychologists: Committee on Ethical Guidelines for Forensic Psychologists, and the Standards for Educational and Psychological Testing. The relevant empirical literature dealing with the phenomenon of social facilitation is also presented. Guidelines are offered for use by the neuropsychologist who receives a request for observation by a third party.

This study provides the first systematic investigation of the stress associated with having a head-injured sibling. The problem-solving abilities, coping styles, family functioning, attributional styles, beliefs, attitudes, and levels of psychological symptomatology of 13 siblings of severely head-i

The Test of Memory Malingering (TOMM) is a method of identifying patients who may be exerting poor effort during neuropsychological testing. This study seeks to examine whether TOMM Trial 1 scores are useful in identifying patients whose overall TOMM performance does not indicate obvious poor effort. Hit rates of adequate performance on Trial 2 and the Retention Trial were calculated based on a fixed criterion of 45 or greater on Trial 1. Archival data were collected from a sample of 77 mild traumatic brain injured litigants and compared to each clinical sample described in the TOMM test manual (Tombaugh, 1996). Results show a hit rate of 100% for each group. Findings reveal that adequate Trial 1 scores predict adequate Trial 2 and Retention Trial scores, suggesting that patients scoring 45 or greater on Trial 1 are not likely to be suspected of poor effort based on overall TOMM performance.

The detection of suboptimal effort has become crucial in clinical neuropsychological practice in order to make accurate diagnoses, prognoses, and referrals. Symptom Validity Testing (SVT) has been the most commonly utilized model for assessing effort, and frequently includes recognition memory tasks. Some conflicting views on this model purport, however, that measures of effort gathered from a recognition memory paradigm do not necessarily extend to effort in other cognitive domains and other areas of performance. The present study sought to investigate whether performance on an SVT measure, which utilizes recognition memory, the TOMM, could predict performance on other measures that do not evaluate recognition memory or just memory per se in a group of mildly traumatic brain-injured litigants. Results indicated that poor performance on the TOMM was significantly correlated with poorer performance on the WAIS-R and the HRNB-A. Further, experimental exploration of these results indicated that the overall neuropsychological performance of litigants with suboptimal effort was poorer than what is generally expected from mild TBI individuals, and was also lower than the other mild TBI examinees in the study, who were not classified by the TOMM as exhibiting suboptimal effort. These findings support the proposition that poor effort as measured by recognition memory effort measures is not restricted to recognition and memory measures. In fact, in the present study it appears that a poor performance on the TOMM is predictive of a generalized poorer performance on standardized measures such as the WAIS-R and the HNRB-A.

The different socializing experiences males and females encounter are reflected in their different attitudes toward specific body areas. Previous findings ( 1 ) suggested that because the male learns to have less anxiety about motility in space than the female, he also has relatively less anxiety about his legs (which are most intimately associated with movement). Further, women who generally learn to be more openly emotionally expressive than men showed relatively less anxiety about the facial regions ( the prime region for emotional communication). Fisher demonstrated this pattern in a study dealing with the differences in aniseikonic perception' of the legs and head in males and females. Females who looked at themselves in a mirror while wearing aniseikonic lenses saw significantly less change in rheir legs than did males, while males saw significantly less change in rheir heads than did females. Earlier, Wittreich and Radcliffe ( 4 ) demonstrated that the greater the anxiety linked with a perceptual target the greater the resistance to perceiving it as perceprually altered when viewing i t aniseikonically. Analogously, it has been shown that when anxiety is attached to a particular body area there is a tendency, when wearing aniseikonic lenses, to resist perceiving it as altered ( 3 ) . Anxiety, in this context, seemingly motivates one to maintain things as they are, thus avoiding potentially threatening change. The present study was an attempt to cross-validate prior findings ( 1 ) concerned with the differences in aniseikonic perception of the legs and head. College students ( 5 3 female, 37 male) were paid for their participation. Their median age was 20 yr. The earlier procedure ( 1 ) for measuring aniseikonic perception of one's body was not employed here; rather a more precise method ( 2 ) was used. Each S was asked to face a full length mirror 5 ft. from him, while wearing the first of three sets of aniseikonic lenses differing in the degree of aniseikonia produced. Three sets were used to increase the reliability of the procedure. A 2-min. acclimation period was given to each S for the first pair of lenses; and verbalization of perceived changes in the walls, floor, ceiling, or door was encouraged. S was then asked to look at his own image and rank order the head, arms, chest, abdomen, pelvis, and legs, proceeding from the area most changed to that least changed. A schematic diagram of the body was provided with each major area of the body designated by a number which S could cite as he made his ranking judgments. This procedure was repeated for each of the two other sets of lenses. Comparison of mean rank of Ss for the three lens trials combined yielded results consistent with expectation. The median rank for legs for men was 3.33 (range k 5 . 3 3 ) and for women was 4.00 (range 0 4 . 0 0 ) . The median rank for head for men was 4.33 (range 0-6.0) and for women 3.33 (range 0-6.0). Employing the Mann-Whitney U test and a one-tail test (since this was a cross-validation effort) , females perceived significantly ( U = 2.34, p < .01) fewer changes in t h e i ~ legs than did males. Also, males perceived significantly ( U = 1.70, p < .05) fewer changcs in the head region than did the females. Sex differences for ranks of other body sectors were not significant. These results completely reaffirm the differences between males and females originally reported by Fisher ( 1964) . REFERENCES 1. FISHER, S. Sex differences in body perception. Psychological Monographs, 1964, 78, No. 14 (Whole No. 5 9 1 ) . 2. FISHER, S., & RICHTER, J. selective effects o f the menstrual experience upon aniseikonic body perceprion. Psychoromatic Medicine, 1969, 31, 367-371. 3. UDDENBERG, N., & HAKANSON, M. Aniseikonic body perception in pregnancy. lournu/ of Prychosoma~ic Medicine, 1972, 16, 179-184. 4. WI'ITREICH, W. J., & RADCLIFFE, K. B. The influence of simulated mutilation upon the perception of the human figure. Journal o f Abnormal and Social Psychology, 1955, 51,493-495. Accepted November 14, 1973.

Summary: The role of oral fantasy in reactions of heavy smokers to smoking deprivation was studied. Experimental subjects were first evaluated with the Holtzman Inkblot Test to measure amount of oral fantasy. They also evaluated themselves on a number of Semantic Differential continua. Smoking deprivation followed. Retest Holtzman blots and Semantic Differential rating scales were then administered. Subjects also indicated number of somatic symptoms and body image distortions produced by deprivation. Control subjects followed the same paradigm except they smoked throughout the procedure, it was found that the greater the orality of experimental subjects the greater the number of somatic symptoms and body distortions they experienced following deprivation; and the more they viewed self as having shifted in a less favorable and less potent direction. Such relationships were absent in the control group.

Sex differences in smoking motivation were evaluated. It was hypothesized that women smoke to satisfy power wishes, whereas men smoke for the comforting regressive body sensations involved. The hypotheses were evaluated by an objective analysis of themes in the stories related by men and women in response to pictures of people in smoking situations. Support was found for the importance of power motivation in the female smoker; but not for the importance of regressive comforting experiences in the motivation of the male smoker. Signficant exploratory findings appeared concerning the role of masculinity-femininity in smoking behavior within sex groups.