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PubMed1993

Malingering and other validity considerations in the neuropsychological evaluation of mild head injury.

Eight malingerers (MPs) were identified via significantly below-chance symptom validity testing (SVT) within a sample of 106 consecutive admissions for neuropsychological evaluation. The resulting incidence of 7.5% is seen as a minimal estimate of malingering within the sample. Eight individuals who "passed" SVT but produced neuropsychological data of questionable validity were also identified (QVs). MPs and QVs were compared with matched controls on 14 measures that have been previously suggested as indicators of invalid neuropsychological data. MPs and QVs differed from controls on General Neuropsychological Deficit Scale, Fingertip Number Writing, and Digit Span. CVLT Recognition, Finger Agnosia, and Speech Perception differed for one of the target groups versus controls and had trends toward significance in the other group. However, many of the previously suggested invalidity signs were rare or absent. Reliance on these measures could result in overconfidence in the validity of neuropsychological data.

Adult↗
PubMed1999

Detecting malingering in head injury litigation with the Word Memory Test.

The Word Memory Test (WMT) is a relatively new computer-based test that is designed to measure both verbal memory and biased responding (i.e. malingering). The purpose of this study was to examine the performance of a large sample of patients involved in head injury litigation on the WMT measures of biased responding. The patients were divided into two groups, those with relatively mild head injuries (n = 234) and those with moderate or severe brain injuries (n = 64). The patients with less severe injuries performed significantly poorer on the WMT measures of biased responding.

Adult↗
PubMed2005

Performance on the test of memory malingering in a mixed pediatric sample.

Performance on the Test of Memory Malingering (TOMM) was evaluated in a sample of 100 consecutively referred 6 to 16-year-old children with a wide range of clinical diagnoses. In the complete sample, 97 children met actuarially defined criteria for sufficient effort on the TOMM. Two children were correctly identified as providing suboptimal effort and only one case was a possible false positive. Performance on the second trial of the TOMM did not vary with gender, ethnicity, parental occupation, performance on an independent memory test, or length of coma. Although younger children tended to be somewhat less efficient on the TOMM than older children, more than 90% of children in the 6-8 years range met criteria originally developed for adults for sufficient effort on the TOMM. It is concluded that the TOMM is a potentially useful measure of effort in the clinical neuropsychological evaluation of school-age children.

Adolescent↗
PubMed2006

Pain, malingering, and performance on the WAIS-III Processing Speed Index.

Pain patients often report cognitive symptoms and many will include them in their claims of disability. The Processing Speed Index (PSI) of the WAIS-III was investigated as one aspect of cognitive functioning in six groups. Slight impairment was found for PSI and Digit Symbol subtest performance, but not for Symbol Search, in a Laboratory-induced Pain group and a Clinical Pain group. The lowest scores were found in a Simulator group instructed to fake cognitive impairment and a Clinical Pain group diagnosed as Malingering. Results suggest that PSI scores are only slightly reduced by laboratory-induced pain or chronic pain, and that unexpectedly low scores in the absence of significant/documented brain dysfunction suggest poor effort or deliberate misrepresentation.

Adolescent↗
PubMed2006

The Henry-Heilbronner Index: a 15-item empirically derived MMPI-2 subscale for identifying probable malingering in personal injury litigants and disability claimants.

A new 15-item MMPI-2 subscale, the Henry-Heilbronner Index (HHI), representing a "pseudosomatic factor," was empirically derived from both the 43-item Lees-Haley Fake Bad Scale (FBS) and the 17-item Shaw and Matthews' Pseudoneurologic Scale (PNS). The HHI was superior to both the FBS and PNS in identification of symptom exaggeration in personal injury litigants and disability claimants compared to non-litigating head-injured controls. Logistic regression analyses revealed that a cutscore of > or = 8 on the HHI was associated with good specificity (89%) and sensitivity (80%). These results suggest that the HHI may be useful in identifying personal injury litigants and disability claimants who exaggerate, overreport, or malinger physical symptoms on the MMPI-2 related to their current health and/or litigation status.

Adult↗
PubMed2006

Has the rolling uterus finally gathered moss? Somatization and malingering of cognitive deficit in six cases of "toxic mold" exposure.

This article reports six cases of litigants claiming neuropsychiatric impairment due to toxic mold exposure. In spite of recent growth in personal injury claims due to mold, numerous reviews of the literature have failed to find an association between environmental exposure to mold and neuropsychiatric and/or neuropsychological damage. We report data on six patients claiming harm, 4 of whom revealed a long history of somatization by history and psychological testing, and 2 of whom were shown to be malingering based on multiple indicators of non-credible performance. Of the 6 patients, only the 2 somatoform patients who were also depressed showed credible evidence of neuropsychological dysfunction. We review two other studies that have examined the link between mold exposure and cognitive impairment and discuss their limitations in view of the presenting behaviors of these 6 patients. Until the literature has established a credible link between mold and neuropsychiatric/neuropsychological impairment, jurists and clinicians must consider the ethics and potential harm of exposing somatoform patients to multiple unwarranted medical evaluations. Principles for forensic evaluations in this special population are reviewed.

Adult↗
PubMed2006

Sensitivity and specificity of MMPI-2 validity scales and indicators to malingered neurocognitive dysfunction in traumatic brain injury.

The present study used a known-groups design to determine the classification accuracy of 10 MMPI-2 validity scales and indicators in the detection of cognitive malingering in traumatic brain injury. Participants were 259 traumatic brain injury and 133 general clinical patients seen for neuropsychological evaluation. The TBI patients were subdivided into groups based on a comprehensive examination of effort following Slick, Sherman, and Iverson's (1999) criteria. More extreme scores demonstrated excellent specificity; often impressive sensitivity was seen even while maintaining a low false positive error rate. Specificity was good even in stroke, memory disorder, and psychiatric patients without incentive. The results of this study are presented in frequency tables that can be easily referenced in clinical practice.

Adult↗
PubMed2006

Replication of the Test of Memory Malingering (TOMM) in a traumatic brain injury and head trauma sample.

The purpose of the current study was to replicate the clinical validation study of the Test of Memory Malingering (Tombaugh, 19961997). Fifty cases were selected from two different participant pools: medically documented traumatic brain-injury patients and compensation-seeking, mild head trauma cases. Results replicated and expanded those found by Tombaugh and indicated that employing a Trial 2 cutting score of greater than 5 errors provided adequate sensitivity to suboptimal effort while demonstrating remarkable insensitivity to cognitively impaired traumatic brain-injury cases. Use of a lower cutting score (e.g., 2 to 5 errors) is also discussed.

Adolescent↗
PubMed1999

What a tangled web we weave: discriminating between malingering and anosmia.

Two groups of normosmic subjects were instructed to feign a total olfactory loss when tested with the Olfactory Confusion Matrix (OCM). One of the groups was given specific instructions as to the number of odorants and trials in the test, as well as the number of items that might be expected to be correctly identified by chance. The responses of both groups of malingerers were compared with responses gathered from a group of anosmic patients. The groups did not differ in terms of performance level (percent correct). In spite of the similarity in terms of accuracy level, an analysis of the pattern of OCM responses to an irritant allowed the anosmic patients to be distinguished from subjects attempting to feign a loss. Subjects were given explicit details about the test performed at the same level as those simply told to feign a loss. These results suggest that the OCM is an effective tool in separating malingering from anosmia.

Adult↗
PubMed1992

Case report: stimulation of severe hypertension as a means of malingering.

Severe hypertension frequently requires hospitalization. Although hospital admission is undesirable for most patients, others are motivated to achieve hospitalization status for secondary gain. The authors present a case of a prison inmate who simulated severe hypertension with a combination of Valsalva's maneuver and arm flexion, on the background of preexisting essential hypertension and mitral valve prolapse. His secondary intent--to avoid his prison duties--classifies him as a malingerer. The differences between this malingering and the psychiatric diagnosis of Munchausen syndrome are discussed. The contributions of essential hypertension and mitral valve prolapse to the self-induced blood pressure elevations also are considered.

Adult↗
PubMed2000

Detecting exaggeration and malingering in neuropsychological assessment.

Magnification of symptoms or nonoptimal effort on neuropsychological tests, within the context of head injury litigation, can have several independent or related underlying causes. Therefore, detecting exaggeration does not automatically indicate that the individual is malingering. This article reviews the evaluative and differential diagnostic process and provides the clinician with suggestions regarding assessment methods. A forensic evaluation that does not include careful consideration of possible negative response bias should be considered incomplete.

Brain Injuries↗
PubMedDate not supplied

Determination of effort level, exaggeration, and malingering in neurocognitive assessment.

OBJECTIVES: This article presents a review of the field of effort level determination in TBI assessment as well as how to determine which effort level measure is most appropriate for common assessment situations. The importance of effort level assessment in forensic settings, and also in assessments conducted in both diagnostic and rehabilitation programs, which rely on test performances to develop treatment plans or to measure progress and outcome, is discussed. METHODS: Historical review and summaries of specific measures designed to characterize effort level in assessment of persons suffering TBI. RESULTS: There are several effort level measures that have withstood the scrutiny of cross-validation research. These include the Computerized Assessment of Response Bias (CARB), Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), Validity Indicator Profile (VIP), Victoria Symptom Validity Test (VSVT), and Word Memory Test (WMT). CONCLUSIONS: Depending on the neurocognitive test performances(s) evidencing suboptimal effort or complaints that may be questionable, it is recommended that at least 2 of the above-listed measures be employed for proper assessment of effort level.

Brain Injuries↗
PubMed1998

Differentiation of conversive sensory loss and malingering by P300 in a modified oddball task.

We applied the methodology of evoked potentials (EP) to reveal the functional level of abnormality in a patient with circumscribed complete anaesthesia due to conversion disorder. EP components related to sensory and perceptual processing of both innocuous electrical and noxious laser stimuli were normal. However, a P300 component indicating cognitive processing failed to appear when using a modified oddball task with rare stimuli applied to the anaesthetic right hand. P300 was present with this paradigm stimulating the healthy left hand, as well as in a 'malingerer' - a healthy subject who was instructed to feign the same deficit. These results suggest cognitive deficits underlying sensory loss as conversion symptom which can be differentiated from malingering by use of P300.

Adult↗
PubMed2003

Malingering by proxy: a form of pediatric condition falsification.

The deliberate production or feigning of signs or symptoms in a child by a caretaker is well recognized as factitious disorder by proxy, a psychiatric condition commonly reported in the pediatric literature. However, it is not as well recognized that the false illness portrayal may also be the result of a parent instructing the child to malinger. A case report of a 13-year-old patient who feigned an immobile upper extremity for the purpose of obtaining a legal settlement is presented. Physicians are encouraged to make protecting the child from parental or iatrogenic harm a priority. Recommendations for careful confrontation and expedient resolution are made.

Accidents↗
PubMed1989

Assessment of visual function in suspected ocular malingering.

Three new techniques are presented for assessing visual acuity in the presence of suspected malingering. The first technique is based on the preferential looking method commonly used to test acuity in infants. The second uses polarising filters to present stimuli briefly to both eyes or to each eye alone, without the patient's being aware of which eye is tested. The third presents the stimuli on a computer monitor and separates the ray paths of the two eyes by means of special spectacles that obscure vision in one eye for fractions of a second while a stimulus is presented.

Humans↗
PubMed1997

Use of the Stroop phenomenon as a diagnostic tool for malingering.

AIMS: To assess a computerised version of the Stroop test for detection of malingering of cognitive deficit. METHODS: Sixty subjects were assessed using this test. Twenty had cognitive deficits due to brain damage of miscellaneous aetiologies. Ten were healthy, not acquainted with the test, and were asked to simulate cognitive impairment. Another 10 simulators were psychology students trained in the use of the test. Twenty healthy subjects served as controls. Results were analysed for reaction time, error percentage, and the Stroop effect. RESULTS: There was a significant difference in reaction time among groups, showing a direct relation of age among control subjects, and also longer reaction time in patients with brain damage than in controls. Controls and patients with brain damage showed a clear Stroop effect. Simulators had a significantly prolonged reaction time, increased error percentage, and inverted or absent Stroop effect. This alteration of the Stroop effect is never present in organic cognitive deficits and seems to be a characteristic pattern of feigning, independently of knowledge of the test. CONCLUSION: This technique is recommended as a valuable tool to detect feigned cognitive impairment.

Adult↗
PubMed1999

Amnestic syndrome presenting as malingering in a man with developmental disability.

The authors report an unusual presentation of amnestic syndrome mislabeled as malingering in a man with mild developmental disability. The case highlights the challenges to medical personnel in treating persons who visit emergency rooms often, particularly individuals with mental retardation. Diagnostic overshadowing was a primary factor in the failure to diagnose amnestic syndrome. Overshadowing occurs when a patient's problematic behaviors are attributed to mental retardation, and no attempt is made to search for the root causes of the problem. The case also highlights the need for emergency room personnel to maintain links with agencies involved in the day-to-day care of persons with developmental disabilities.

Amnesia↗
PubMed2002

The use of reliable digits to detect malingering in a criminal forensic pretrial population.

The present research is a cross-validation of previous investigation by Greiffenstein, Baker; and Gola; Greiffenstein, Gola, and Baker; and Meyers and Volbrecht on the reliable digits (RELD) method of detecting suspected malingering on the Wechsler Adult Intelligence Scale-Revised (WAIS-R). The results support the use of the RELD method on a criminalforensic pretrial population (N = 187). Sensitivities, specificities, and incremental hit ratesfor two cut levels of the RELD method, Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Infrequency and the Personality Assessment Inventory Negative Impression Scales, as well as multiple combined cut scores, were comparable to those observed in previous studies that used neuropsychologically evaluated participants. The selection of which cut score or combination of cut scores is appropriate on the RELD method is also discussed.

Adult↗