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PubMed2005

Should the Retention trial of the Test of Memory Malingering be optional?

The present study examined the false negative error rate associated with the optional use of the Retention trial the Test of Memory Malingering (TOMM). TOMM scores from 150 traumatic brain injury and 150 chronic pain patients were examined. Results indicated that early termination of the TOMM resulted in 3% of patients going undetected by the TOMM. The practical cost of this error was minimized by the inclusion of at least one other SVT. Clinical implications are discussed.

Brain Injuries↗
PubMed2005

Coverage of the Test of Memory Malingering, Victoria Symptom Validity Test, and Word Memory Test on the Internet: is test security threatened?

In forensic neuropsychological settings, maintaining test security has become critically important, especially in regard to symptom validity tests (SVTs). Coaching, which can entail providing patients or litigants with information about the cognitive sequelae of head injury, or teaching them test-taking strategies to avoid detection of symptom dissimulation has been examined experimentally in many research studies. Emerging evidence supports that coaching strategies affect psychological and neuropsychological test performance to differing degrees depending on the coaching paradigm and the tests administered. The present study sought to examine Internet coverage of SVTs because it is potentially another source of coaching, or information that is readily available. Google searches were performed on the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Word Memory Test. Results indicated that there is a variable amount of information available about each test that could threaten test security and validity should inappropriately interested parties find it. Steps that could be taken to improve this situation and limitations to this exploration are discussed.

Humans↗
PubMed2006

Malingering on the Social Security disability consultative exam: a new rating scale.

In disability examinations, benefits may depend on the findings of a psychological consultative examination (PCE), which in Louisiana usually involves a mental status examination and a Wechsler Scale. The disability determinations service (DDS) requires a warning that failure to do one's best may result in an unfavorable decision on the claim, but psychologists are officially discouraged from determining effort by the use of formal effort tests. Consequently, there is a need for internal indicators of effort. Formal testing of effort was undertaken in order to identify indicators of effort within the PCE in WAIS-age and WISC-age claimants. Our findings indicated that the total score of indicators was more predictive of effort than any single indicator. Regression equations yielded information on how much effort contributes to IQ. Classification accuracy for the new rating scale was described for a "dose-response" of effort. Disincentives for malingering detection in the PCE were identified.

Adolescent↗
PubMed2002

Event-related potentials reveal processing differences in honest vs malingered memory performance.

Twenty-two undergraduate students completed a recognition memory test while event-related potentials (ERPs) were recorded. During the testing phase, subjects distinguished old from new words in a forced-choice format. There were two counterbalanced within-subject conditions, one in which subjects performed to the best of their abilities, and another with instructions to feign memory impairment. Test scores and response latencies differed significantly between the two conditions. Analysis of PCA-defined epochs revealed that old words were more positive than new in the control condition, with this difference confined to frontal regions and interpreted as reflecting familiarity-based recognition judgements. In the malingering task, this old/new word difference emerged earlier and was broadly distributed across the scalp. A discriminant function analysis using reaction time and ERP measures resulted in 82% correct classification of honest and simulated performance, with 79% correct on cross-validation.

Adolescent↗
PubMed2003

The ability of the Millon Clinical Multiaxial Inventory--Third Edition to detect malingering.

This study investigated the ability of the Millon Clinical Multiaxial Inventory--Third Edition (MCMI-III) to discriminate students malingering psychopathology (n = 106) from bona fide psychiatric inpatients (n = 202). Students were randomly assigned to a fake-bad or an honest-responding condition. Analyses investigated the ability of the modifier indices to discriminate fake-bad group participants from the psychiatric inpatients. Scale X raw cutoff score > 178 yielded a positive predictive power (PPP) of 0.0, a negative predictive power (NPP) of 63.1, and a hit rate of 63.1%. Optimal cutoff scores were developed. Scale X Base Rate (BR) > 84 provided a PPP of 55.6, an NPP of 72.1, and a hit rate of 65.2%. Scale Y BR < 26 yielded a PPP of 52.5 and a hit rate of 64.8%. Receiver operating characteristic analyses found that Scale X best classified malingerers. Overall, the MCMI-III modifier indices were of minimal clinical utility in distinguishing college student malingerers from bona fide psychiatric inpatients.

Adult↗
PubMed2000

Evaluation of a WMS-R malingering index in a non-litigating clinical sample.

The purpose of this study was to examine the prevalence of a Wechsler Memory Scale-Revised "malingering index" in a large sample of non-litigating individuals from an inpatient substance abuse program. Past research has demonstrated that experimental-malingerers often obtain substantially lower scores on the Attention/Concentration Index than on the General Memory Index. In the present study, only a small percentage of patients showed large General Memory - Attention/Concentration difference scores. These results provide further support for the validity of this difference score as a marker for non-optimal effort.

Adult↗
PubMed2002

How'd they do it? Malingering strategies on symptom validity tests.

Twenty-five undergraduate students were instructed to feign believable impairment following a brain injury from a car accident and 27 students were told to perform like they had recovered from such an injury. Three forced-choice tests, the Test of Memory Malingering (TOMM), Victoria Symptom Validity Test (VSVT), and Word Memory Test (WMT) were given. Test-taking strategies were evaluated by means of a questionnaire given at the end of the test session. The results revealed that all the tasks differentiated between groups. Using conventional cut-scores, the WMT proved most efficient while the VSVT captured the most participants in the definitive below-chance category. Individuals instructed to feign injury were more likely to prepare prior to the experiment, with feigning of memory loss as the most frequently reported strategy. Regardless, preparation effort did not translate into believable performance on the tests.

Adult↗
PubMed2003

Detection of symptom exaggeration with the MMPI-2 in litigants with malingered neurocognitive dysfunction.

MMPI-2 scores of 26 persons identified as meeting criteria for definite malingered neurocognitive dysfunction (MND), were contrasted with the MMPI-2 scores of 29 persons who had suffered moderate or severe closed head injury. The Lees-Haley Fake Bad Scale (FBS) was the most sensitive MMPI-2 scale in discriminating the malingerers from the head-injured persons, with additional significant differences obtained on standard MMPI-2 clinical scales including Scales 1 (Hs), 2 (D), 3 (Hy), 7 (Pt), and 8 (Sc). Correlational analyses on a larger sample combining additional subjects with evidence of possible or probable MND, with the original sample and the head injured subjects, demonstrated the concurrent validity of the FBS, which correlated with the Portland Digit Recognition Test (PDRT), and with Scales 1 (Hs), 2 (D), 3 (Hy), and 7 (Pt) of the MMPI-2.

Analysis of Variance↗
PubMed2003

Exaggerated pain report in litigants with malingered neurocognitive dysfunction.

Twenty-nine litigants who met criteria for either definite or probable malingered neurocognitive dysfunction and reported chronic pain produced scores on the McGill Pain Questionnaire (MPQ), Pain Disability Index (PDI), and Modified Somatic Perception Questionnaire (MSPQ) that were significantly higher than scores produced by large samples of clinical pain patients. At 0.90 specificity, the MPQ, PDI, and MSPQ yielded sensitivities of 0.21, 0.59, and 0.90, respectively. The MSPQ alone, correlated significantly with the Lees-Haley Fake Bad Scale (FBS). Overall, the MSPQ is superior to the MPQ and PDI for detection of exaggerated pain symptoms.

Adult↗
PubMed1998

Effects of coaching on malingered motor function profiles.

Measures of motor functioning were evaluated to assess a nonphysiological performance pattern initially revealed in a sample of litigating patients with postconcussive syndrome (grip strength < finger tapping < grooved pegs). The opposite pattern is observed in patients with traumatic brain injury, whose performance follows a gradient of increasing impairment corresponding to the sensory-motor complexity of these tasks. Naive and coached malingerers performed worse on all three motor tests relative to controls (N = 92); however, the presence of nonphysiologic configurations showed poor predictive accuracy among malingerers and controls. Exploratory analyses suggested that IQ may mediate the ability to dissimulate successfully. Although worthy of additional study, the use of pattern analysis in evaluation of malingered motor functioning has not been proven reliable or valid.

Adolescent↗
PubMed2000

Using the WMS-III to detect malingering: empirical validation of the rarely missed index (RMI).

To detect malingering during memory assessment, we evaluated item response biases to the Logical Memory Delayed Recognition (LMDR) subtest of the WMS-III. In a sample of 50 healthy volunteers who were completely naïve to the content of the Logical Memory stories, 6 LMDR items were correctly endorsed above chance probabilities. These 6 rarely missed items significantly discriminated 51 patients with neurological impairment from 36 volunteers who attempted to feign head injury and poor cognitive performance. A weighted combination of the 6 items was summed to form a single Rarely Missed Index (RMI). The RMI accurately classified over 98% of participants and demonstrated high sensitivity (97%) and specificity (100%) in discriminating between analog malingerers and patients. Because the RMI is calculated directly from the LMDR items, it has the advantage of requiring no additional administration time or materials, and thus may serve as a quick screen for dissimulation that can be obtained without additional testing.

Adolescent↗
PubMed2001

Assessment of response bias in mild head injury: beyond malingering tests.

The evaluation of response bias and malingering in the cases of mild head injury should not rely on a single test. Initial injury severity, typical neuropsychological test performance patterns, preexisting emotional stress or chronic social difficulties, history of previous neurological or psychiatric disorder, other system injuries sustained in the accident, preinjury alcohol abuse, and a propensity to attribute benign cognitive and somatic symptoms to a brain injury must be considered along with performances on specific measures of response bias. This article reviews empirically-supported tests and indices. Use of the likelihood ratio and other statistical indicators of diagnostic efficiency are demonstrated. Bayesian model averaging as a statistical technique to derive optimal prediction models is performed with a clinical data set.

Algorithms↗
PubMed2003

A validation of the test of memory malingering in a forensic psychiatric setting.

The Test of Memory Malingering (TOMM) has not been adequately validated in a forensic psychiatric setting. Dissimulation of cognitive impairment, as assessed by the TOMM, was evaluated in a group of 25 forensic inpatients admitted for evaluation of Competency to Stand Trial (CST/MSO group), and hypothesized to be at higher risk for feigning cognitive impairment. A comparison group of 36 patients, who were either civilly committed or adjudicated Not Guilty by Reason of Insanity (CIVIL/NGRI group), were hypothesized to be less likely to feign cognitive impairment. Groups were comparable in age, education, premorbid intelligence, and psychiatric symptom severity. Significantly more CST/MSO patients (36%) scored below a recommended TOMM cutoff score relative to CIVIL/NGRI patients (6%). Findings indicate excellent specificity and modest sensitivity, and generally support the validity of the TOMM in a forensic psychiatric population. The utility of different cutoff scores and need for multiple indicators of effort are discussed.

Adult↗
PubMed2004

Detecting poor effort and malingering with an expanded version of the Auditory Verbal Learning Test (AVLTX): validation with clinical samples.

Three studies describe the development and validation of a new procedure (AVLTX) to detect inadequate effort or malingering by adding 60-min delayed recall/recognition trials and identifying "impaired" memory performances that are highly inconsistent with performances of brain-damaged (BD) individuals. In Study I, AVLTX performances of 25 probable malingerers (PMs) were compared with those of 43BD and 40 psychiatric patients (PSYs). Seven inconsistencies were identified and converted to scaled inconsistency scores, yielding the exaggeration index (EI). Study II reported cross-validation in an independent sample of 34 PM, 70BD and 89 PSY, showing sensitivity of 0.59 and specificities of 0.97 (BD) and 0.92 (PSY). Study III compared the diagnostic accuracy of the EI with two well-established effort assessment paradigms, exemplified by the RMTand DRT (a symptom validity test). The RMT showed excellent sensitivity and poor specificity; the DRT showed poor sensitivity and excellent specificity; the EI showed good sensitivity and excellent specificity. Adding a second delayed trial to list-learning tests can be a time-efficient procedure to detect inadequate effort.

Adult↗
PubMed2003

Trail making test cut-offs for malingering among cocaine, heroin, and alcohol abusers.

The Trail Making Test (TMT) is frequently used to screen for cognitive impairments in substance abusers; however, an existing problem is that substance abusers may give poor effort and the TMT results may not be valid. In this study, cutting scores for malingering were developed from three samples drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS), a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 drug abuse treatment programs in 11 cities in the United States. The DATOS enrolled 7689 substance abusers. The three drawn samples were for subjects with primary drugs of abuse. Number of subjects were as follows: alcohol-1000, cocaine/crack-4306, heroin-1548. Data were analyzed to determine number of substance abusers that fell beyond the upper end of the distribution of TMT scores at the ten, five, and one percentiles. These percentiles were set for alcoholics, cocaine abusers, and heroin abusers. The proper use of the cut-off scores is to alert clinicians to the increasingly higher probability of poor effort when a substance abuser in one of the three groups scores beyond the one percent cut-off or his or her sample of primary drug of abuse. Clearly, the use of these cut-offs needs further empirical validation.

Adolescent↗
PubMed2006

Abbreviated form of the test of memory malingering.

The Test of Memory Malingering (TOMM) is a neuropsychological effort test in which scores below 45 on Trial 2 or Retention Trial indicate insufficient effort on testing, but Trial 1 score is not used. This study attempted to identify Trial 1 cut points above and below which further trials need not be administered. Data were analyzed from 114 patients referred for clinical neuropsychological evaluation. Sensitivity, specificity, and positive and negative predictive value for identifying failure on TOMM were calculated. Trial 1 scores > or =36 indicated 99% likelihood that TOMM would be passed; Trial 1 scores < or =27 indicated 100% likelihood of failure.

Adult↗
PubMed1993

Assessment of malingering after mild head trauma with the Portland Digit Recognition Test.

The Portland Digit Recognition Test (PDRT), a forced-choice measure of recognition memory designed for the purpose of assessing the possibility of malingering, was administered to two groups of clinically referred patients seeking financial compensation for injuries including a mild head trauma group and a brain dysfunction group and also to a third group with brain dysfunction not seeking compensation. The three groups were equated on verbal acquisition ability. The two groups seeking remuneration were impaired on the PDRT compared with the group not seeking compensation, and the brain dysfunction group seeking compensation was superior to the mild head trauma group. Cut-off scores were established for the group with brain dysfunction not seeking compensation, and 33% of the mild head trauma group and 18% of the brain dysfunction group seeking compensation fell below the cut-offs. Significantly below chance scores were found in 17% and 3% of the two groups seeking compensation, respectively. Difficult PDRT items were more sensitive than easy items to compensation-related deficit. The PDRT is recommended as a measure of exaggeration of memory deficits.

Adult↗