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PubMed2000

Effects of coaching on detecting feigned cognitive impairment with the Category test.

In a replication and extension of previous research (Tenhula & Sweet, 1996), the current study investigated the utility of the Category Test (CT) for detecting feigned cognitive impairment. Ninety-two undergraduate participants were randomly assigned to one of three groups and administered the CT. A Coached Simulator group was instructed to simulate cognitive impairment and was provided test-taking strategies to avoid detection. An Uncoached Simulator group was simply instructed to feign impairment. A control group was instructed to perform optimally. In addition, the CT results of 30 traumatic brain injury (TBI) patients were analyzed. The results largely supported the utility of five CT malingering indicators identified by Tenhula and Sweet: (a) number of errors on subtests I and II, (b) number of errors on subtest VII, (c) total CT errors, (d) number of errors on 19 "easy" items, and (e) number of criteria exceeded. Correct Classification rates of the five indicators for Uncoached Simulators and optimal performance controls ranged from 87% to 98%. Correct Classification rates for the TBI patients ranged from 70% to 100%. In addition, significantly more Coached Simulators were misclassified as nonsimulators on four of the CT malingering indicators, relative to their Uncoached counterparts. A decision rule of > 1 error on subtests I and II was consistently the most accurate malingering indicator, regardless of degree of coaching or presence of TBI. This indicator correctly classified 76% of all simulators and 100% of the optimal performance controls and TBI patients. Implications of providing persons with test-taking strategies and the utility of these CT malingering indicators for various populations are discussed.

Clinical Trial↗
PubMed1989

MMPI profiles of malingerers diagnosed in pretrial forensic evaluations.

The MMPI has several indices associated with exaggeration of symptomatology, but they have seldom been researched with actual malingering subjects. Based upon interview behavior during pretrial forensic evaluations, samples of malingering (n = 18), psychotic (n = 17), and nonpsychotic (n = 36) criminal defendants were assembled for the present study. Both the malingerers and the psychotics either were untestable or produced incomplete or random MMPIs in about 50% of the cases. Comparisons of remaining profiles revealed significant differences between malingerers and other groups on several MMPI scales and F-K index. Discriminant analysis accurately classified malingerers and psychotics on the basis of MMPI variables. The MMPI may have considerable utility to detect malingering when subjects cooperate with testing.

Expert Testimony↗
PubMed1995

Detecting simulated amnesia with event-related brain potentials.

Two experiments were done in which groups of normal college undergraduate subjects were instructed to simulate autobiographical amnesia related to head injury. The subjects were tested for autobiographical knowledge with pencil-and-paper recall and recognition tasks, and on another day, with recognition tasks in which event-related potentials were recorded in response to the same autobiographical items, this time presented on a display screen. In the first study, three Event-Related Potential (ERP) block types were utilized: 1) a block in which the subject's birthdate was an oddball with p = 0.11 and other dates (not relevant to the subject) had p = 0.89, 2) a block in which phone numbers were used as stimuli, and 3) a block in which (mothers' maiden) names were used as stimuli. Only birthdate blocks were used in the second study. A P300 ERP was seen in response to rare, personally relevant items. In both studies, the main effect of stimulus type (personally relevant versus not personally relevant) on P300 amplitude was significant (p < 0.0001) and there was no main effect of block type in the first study. Under a sophisticated malingering instruction set, about 15% of the items were correctly recalled and about 50% were correctly recognized by simulators in pencil-and-paper tests. Under a naive malingering instruction set, most simulating subjects failed to recall and recognize autobiographical items. In the first study, an arbitrarily but a priori derived discrimination criterion based on a subject's average P300 amplitude afforded 92% correct discrimination of simulating individual subjects for birthdates and phone numbers. The value was 77% for mothers' maiden names. The same criterion applied to the single birthdate block in the second study yielded 93% correct discrimination. The results suggest the P300 may be useful in detection of malingered amnesia.

Amnesia↗
PubMed2004

Performance profiles and cut-off scores on the Memory Assessment Scales.

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.

Adult↗
PubMed2006

Computerized binary scale of auditory speech hallucinations (cbSASH).

BACKGROUND: Evidence indicates that the neuropathology of auditory verbal hallucinations (AVH) varies according to their phenomenological characteristics. Therefore, AVH should be subgrouped accordingly in hallucinations research. As evaluation of these characteristics depends entirely on the patient report, obtaining measurement of the reliability of these reports is crucial. METHOD: A computerized binary scale of auditory speech hallucinations (cbSASH) was developed to evaluate the phenomenology of AVH. It includes two subscales (inconsistency and malingering) to assess the reliability of the patient report. The cbSASH was administered along with MMPI-2, a general psychopathology scale, which includes similar validity subscales. Thirty-four psychotic patients with history of AVH were enrolled in this study. RESULTS: The scores on the inconsistency and malingering subscales of the cbSASH were correlated with the scores on the corresponding validity subscales in the MMPI-2. The combination of the malingering and inconsistency subscales provided robust measures of the reliability and ability of the patients' descriptions of their hallucinations. CONCLUSION: The cbSASH provides a reliable and comprehensive evaluation of the phenomenology of AVH. Consequently, it is possible to subgroup patients according to the characteristics of their hallucinations. This refinement of AVH phenotypes could reduce the noise and inconsistency noted in AVH and psychosis research.

Adult↗
PubMed2000

Development and validation of the Validity Indicator Profile.

The Validity Indicator Profile (VIP; Frederick, 1997) is a two-alternative forced choice (2AFC) procedure intended to identify when the results of cognitive and neuropsychological testing may be invalid because of malingering or other problematic response styles. The test consists of 100 problems that assess nonverbal abstraction capacity and 78 word-definition problems. The VIP attempts to establish whether an individual's performance in an assessment battery should be considered representative of his or her true overall capacities (valid or invalid). Performances classified as valid are classified as "compliant" and reflect a high effort to respond correctly. Performances classified as invalid are subclassified as "careless" (low effort to respond correctly), "irrelevant" (low effort to respond incorrectly), or "malingering" (high effort to respond incorrectly). The VIP development sample included 944 nonclinical participants and 104 adults undergoing neuropsychological evaluation. The cross-validation sample consisted of 152 nonclinical participants, 61 brain-injured adults, 49 individuals considered to be at risk for malingering, and 100 randomly generated VIP protocols. The nonverbal subtest of the VIP demonstrated an overall classification rate of 79.8%, with 73.5% sensitivity and 85.7% specificity. The verbal subtest of the VIP demonstrated an overall classification rate of 75.5%, with 67.3% sensitivity and 83.1% specificity.

Adolescent↗
PubMed1998

A comparison of forensic and nonforensic malingerers: a prototypical analysis of explanatory models.

Explanatory models of malingering strive to understand the primary motivation underlying attempts to feign. Rogers, Sewell, and Goldstein (1994) provided empirical support for the conceptualization of pathogenic, criminological, and adaptational models. In the current study, a prototypical analysis of 221 forensic experts results in a slightly refined formulation: the adaptational models was decomposed into its two broad dimensions (cost-benefit analysis and adversarial setting). An important findings is that the factor structure for the explanatory models remained stable when applied to both forensic and nonforensic cases. As a first investigation, significant differences were observed in prototypical cases of malingering by the category of referral (forensic or nonforensic) and by type of feigning (mental disorders, cognitive impairment, and medical syndromes). Surprisingly, the feigning of medical syndromes appeared to play a relatively prominent role in both forensic and nonforensic cases and to be influenced by the apparent adversarial context of the assessment. Finally, important gender differences were observed, especially with nonforensic prototypical cases of malingering.

Adaptation, Psychological↗
PubMed2001

[The closed Landolt ring--a handy test for evaluating suspected simulation].

PURPOSE: We present a visual acuity test for proof of malingering and psychogenic impairment of visual acuity. METHOD: The book contains 36 plates. On 32 plates, a Landolt-C is shown with a gap of 10 minutes of arc, thus corresponding to a visual acuity of 0.1, when applied at a distance of 1 metre. Each of the 4 alternatives of the Landolt-C occurs eight times in random order. Starting at position 21, four plates are interspersed showing a closed circle of the same size. The test is used at a distance corresponding to an acuity level of maximum 50% of the presumed factual acuity. Following a four alternative forced choice paradigm, the tested person is requested to call the direction of the Landolt-C within about 2 seconds, when the plates of the book are turned over. The responses and their latency are recorded using a digital electronic system which allows later audiovisual analysis. The response on the first closed circle and its latency is compared to the previous responses. Two subjects were tested who tried to pretend a reduction of their visual acuity. RESULTS: Malingering was proved by the verbal response of the first subject and by the long latency of the response of the second subject (4.0 s vs. 1.2 s-2.7 s for the previous responses). The entire test, explanation included, took less than 5 minutes. CONCLUSION: This handy test can be a useful tool in cases suspect of malingering or psychogenic impairment of visual acuity.

Adult↗
PubMed1999

Impact of somatoform symptomatology on credibility of cognitive performance.

Although the detection of conscious fabrication (i.e., malingering) of cognitive symptoms has been the recipient of burgeoning interest within the last 10 years in the empirical and clinical neuropsychological literature, whether conversion/somatization results in similarly noncredible cognitive profiles has not been formally investigated. Two thirds (13 of 19) of subjects with cognitive complaints and 1-3/3-1 code types on the MMPI/MMPI-2 showed evidence of noncredible cognitive performance (i.e., failure on malingering tests and/or a "malingering" pattern on standard neuropsychological tests). These results suggest that symptom fabrication associated with somatization/conversion personality orientations can extend to noncredible cognitive complaints and not just the oft-described physical manifestations.

Adolescent↗
PubMed2000

Comparison of time and error rates on the trail making test among patients with head injuries, experimental malingerers, patients with suspect effort on testing, and normal controls.

Clinical utility of completion time and performance errors was investigated for the Trail Making Test (TMT; Reitan, 1958). Archival neuropsychological files for patients with mild and moderate/severe head injuries, as well as patients with suspect effort on neuropsychological testing, were examined and compared to controls and experimental malingerers. Time-to-completion scores differentiated the participants who were malingering and who gave suspect effort from those patients with head injuries. There were no differences in error rates among the head-injury groups or controls for either the TMT-A or TMT-B. Errors were also not uncommon among normal controls; 12% and 35% of the controls made at least one error on TMT-A and TMT-B, respectively. However, error rates for both the suspect-effort and malingering groups were inflated on TMT-B as compared to the head-injured and control groups. Results suggest that performance errors on the TMT lack diagnostic utility for persons with head injuries, and time-to-completion is still the best indicator of neuropathology. However, performance errors, in conjunction with inflated time scores on the TMT, may be useful in the assessment of malingering.

Analysis of Variance↗
PubMed2001

Classification accuracy of the portland digit recognition test in traumatic brain injury.

This study examined the classification accuracy of the Portland Digit Recognition Test (PDRT) in traumatic brain injury (TBI). It differs from past studies in assigning patients to malingering and control groups on the basis of compensation-seeking status and the presence of external markers for malingering. Sensitivity and Specificity were.77 and 1.00, respectively. Past research comparing compensation-seekers to noncompensation-seekers reported Sensitivities of.33 or lower (Specificity is always high). This study demonstrates that past research has seriously underestimated the Sensitivity of the PDRT and raises questions about the true Sensitivity of other malingering techniques as well.

Adult↗
PubMed2004

Exaggeration index for an expanded version of the auditory verbal learning test: robustness to coaching.

Recent research suggests that effort detection measures based on patterns of neuropsychological performance may be more robust to coaching than traditional effort detection measures. In the present study, we evaluated the Exaggeration Index for an extended version of the Auditory Verbal Learning Test (EI-AVLTX), a recently developed effort detection instrument based on patterns of performance on the AVLT using a simulated malingering paradigm. In two independent samples, the EI-AVLTX was1 found to be relatively sensitive and specific to malingering, and robust to the effects of a warning about malingering detection.

Acoustic Stimulation↗
PubMed2004

The relationship between malingerers' intelligence and MMPI-2 knowledge and their ability to avoid detection.

One of the most frequently administered psychometrics is the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Occasionally, those participants taking the MMPI-2 will malinger or exaggerate their symptoms. Several malingering detection devices are available, and a significant body of literature exists concerning their efficacy. However, little research is available considering those factors that facilitate successfully evading detection as a malingerer. Some of these studies have identified general intelligence and knowledge of the MMPI-2 as key variables in the likelihood of escaping detection as a malingerer. The extant research considered the utility of general intelligence and knowledge of the MMPI-2 as predictors in avoiding detection as a malingerer. To detect malingering, the two traditional detection devices were employed: the F-Scale and the F - K Index. Results indicate that intelligence and MMPI-2 knowledge contribute significantly to the likelihood of successfully escaping detection as a malingerer.

Aptitude↗
PubMed2001

Evading detection on the MMPI-2: does caution produce more realistic patterns of responding?

Studies on MMPI and MMPI-2 malingering indexes often sacrifice generalizability in an attempt to control internal validity. This study improves external validity while still maintaining internal validity by providing graduate student participants with a realistic context for malingering on the MMPI-2 (n=94) and MMPI (n=30). Contextual parameters include a realistic life predicament, psychological knowledge, an incentive, the presence versus absence of a specific diagnosis, and a caution to be realistic. This study found that cautioning participants not to overexaggerate their responses significantly improves their ability to evade detection on the MMPI-2 and MMPI. Standard malingering indexes (Infrequency, F; Back Side, F, Fb; F-Correction, F-K; and Infrequency-Psychopathology, F(p)) were insufficiently sensitive in identifying simulators using common cutoff scores for these cautious simulators.

Adult↗
PubMed2005

Validity of the Miller forensic assessment of symptoms test in psychiatric inpatients.

This study investigated the validity of the Miller Forensic Assessment of Symptoms Test (M-FAST), a brief measure of malingering, in an inpatient psychiatric sample of 70. Among those patients who also completed the Personality Assessment Inventory (N=44), Total M-FAST score was related in the expected directions to the Personality Assessment Inventory validity scales and indexes, providing evidence for concurrent validity of the M-FAST. With the PAI malingering index used as a criterion, we examined the diagnostic efficiency of the M-FAST and found a cut score of 8 represented the best balance of sensitivity, specificity, positive predictive power, and negative predictive power. Based on this cut-score of 8, 16% of the population was classified as malingering. The M-FAST appears to be an excellent rapid screen for symptom exaggeration in this population and setting.

Adult↗
PubMed2004

Head injury and the ability to feign neuropsychological deficits.

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.

Case-Control Studies↗
PubMed1990

Clinical experiences with post-traumatic fibromyalgia syndrome.

Fibromyalgia syndrome (FS) is a musculoskeletal problem that has become more and more widely recognized. There are three types: primary (PFS idiopathic), secondary (associated with another disorder), and post-traumatic (PTFS). The latter condition, PTFS, is especially intriguing since quite often litigation is involved, and doubt is cast as to whether the patient is actually suffering. Accusations of malingering have been made. A retrospective chart review of 14 PTFS patients was made in an effort to ascertain the likelihood of malingering. Over the past two years, 14 patients (three male, 11 female) were treated for PTFS. The mean age was 37 years for both men and women. All had classic PTFS with a chronic musculoskeletal problem that started immediately after a traumatic event, classic myofascial tender points, poor sleep, and normal standard laboratory tests. Twenty-three per cent went to trial; 77 per cent settled out of court. All were given a monetary award. The vast majority (77 per cent) returned to a rheumatologist for continued treatment, suggesting that patients who meet strict FS criteria are not malingering and are indeed in need of medical help.

Adult↗
PubMed1996

Persistent neuropsychological deficits following whiplash: evidence for chronic mild traumatic brain injury?

OBJECTIVE: To investigate claims of neuropsychological evidence for acquired brain damage (axonal degeneration) in chronic whiplash. DESIGN: Fifteen whiplash patients (Whiplash) were compared with 10 patients who had documented moderate-to-severe head injury (Mod-Sev), and with 24 patients who had chronic pain syndrome (CPS) and no history of head injury on two tests of mental efficiency considered highly sensitive to and specific for the subtle effects of brain trauma. All 3 groups, assessed 4 years after onset in a teaching hospital setting were matched for age, education, and IQ. Exclusion criteria included narcotics/benzo-diazepines or (suspected) malingering. Subjective ratings of depression and pain were collected as well as objective indices of outcome (return to work/school). MEASURES: Neuropsychological test scores were subjected to ANOVA followed by regression analysis regarding the possible effects of age, IQ, pain, and mood ratings. RESULTS: No differences between the Whiplash, Mod-Sev, or CPS groups on the neuropsychological tests emerged. IQ was strongly related to mental efficiency. Counterintuitively, Mod-Sev patients complained of less depression and pain than did Whiplash or CPS patients (where no differences were seen) and displayed a better outcome. Finally, although results from 3 of the original 18 patients in the Whiplash group were later discarded for malingering, no malingering was detected in the 2 other groups. CONCLUSIONS: The theory of neuronal degeneration in the etiology of whiplash-related cognitive complaints was not supported, nor was the specificity of neuropsychological tests in detecting the subtle effects of brain trauma.

Adult↗