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PubMed1998

Effect of warning on feigned malingering on the WAIS-R in college samples.

Research indicates claimant malingering of cognitive deficits to be common in personal injury litigation. Efforts have been made to either detect such tendencies or deter efforts at malingering. The present study examined whether warning people that feigned malingering efforts would be detected results in more valid profiles on the Wechsler Adult Intelligence Scale-Revised. Undergraduates (N = 48) were randomly assigned to one of three conditions: feigned malingerers without warning, feigned malingerers with warning, and controls. Analysis indicated both feigned malingerer groups performed significantly worse than the control group; however, feigned malingerers with warning did not perform significantly better than those without warning. Unlike previous research using the Wechsler Memory Scale-Revised, results did not support effectiveness of warning in reducing feigned malingering scores.

Adult↗
PubMed1995

Qualitative aspects of malingered memory deficits.

Much has been written in recent years on methods for detecting malingered memory deficits. However, previous research has focused exclusively on quantitative analyses of the data. The purpose of this study was to investigate more qualitative aspects of malingering. Undergraduates, community volunteers, psychiatric inpatients, and federal inmates who participated in analogue malingering studies were interviewed to elicit their self-reported strategies for faking memory impairment. Some of these subjects indicated that if they were to malinger they may show poor cooperation, aggravation and frustration, slow response times and frequent hesitations, and general confusion during the testing process. The strategy reported with the greatest frequency was to fake total amnesia (i.e. for personal identity, past knowledge, family and friends, and all aspects of the accident.

Adolescent↗
PubMedDate not supplied

Comparison of visual evoked potentials in patients with psychogenic visual disturbance and malingering.

PURPOSE: To verify the efficiency and objectivity of the pattern visual evoked potential (VEP) for organic disorders of the cortical visual system. METHODS: This retrospective study evaluated VEP in 19 patients diagnosed with psychogenic visual disturbance, 7 patients with malingering, and 37 age-matched normal volunteers. Transient (3 reversals per second) and steady-state (12 reversals per second) pattern VEPs for check sizes 15' and 30', with a contrast of 80%, were recorded. RESULTS: The amplitudes of both transient and steady-state pattern VEPs were significantly increased in patients with psychogenic visual disturbance, while patients with malingering had significantly lower amplitudes. P100 peak latency was prolonged in both groups of patients. CONCLUSION: Monitoring of patients' fixation on the stimulus showed those with psychogenic visual disturbance fixated well on the stimulus, while those with malingering did not. This finding produced a VEP amplitude reduction in patients with malingering. The reason for the VEP amplitude in patients with psychogenic visual disturbance is unclear.

Adolescent↗
PubMed2001

Post-Daubert admissibility of scientific evidence on malingering of cognitive deficits.

In Daubert v. Merrell Dow Pharmaceuticals, Inc. (1993) the Supreme Court held that evidence must be "reliable" to be admissible and for scientific evidence "evidentiary reliability" is based on scientific validity. This article addresses the question "Do the Rey 15-Item Test ('FIT'), the Test of Memory Malingering ('TOMM'), and the Validity Indicator Profile ('VIP') likely meet the Daubert standard for admissibility of scientific evidence?" Sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively), and base rates of 30 and 15 percent were calculated for each test. Given the existing literature on malingering and the implications of a misclassification of malingering, we discuss the findings for each of the three tests using a PPV > or = 80 percent with a base rate of malingering of < or = 30. Our analyses indicate that the Rey 15-FIT fails to meet this standard of scientific validity. In contrast, the TOMM shows high specificity and PPV, and our findings suggest cautious optimism regarding the VIP. These results are discussed within the context of the courts' guidelines for the Daubert standard.

Cognition Disorders↗
PubMed2001

Not just malingering: syndrome diagnosis in traumatic brain injury litigation.

When patients present with syndromes we mistrust or misunderstand, clinician are often quick to make a determination of malingering. However, the use of malingering as a default diagnosis neglects a variety of clinical possibilities that may be relevant for treatment and forensic disposition. In neuropsychology, the growing use of a malingering diagnosis has recently been fueled by the increasingly adversarial nature of forensic brain injury litigation in which the goal is often less to provide an objective evaluation of cognition and personality as to brand all personal injury claimants as manipulative frauds. Less maliciously, but still disturbing, neuropsychologists whose knowledge base and clinical experience involves mainly the administration and scoring of psychometric tests may ignorantly, if innocently, overlook alternative diagnoses and syndromes that their education and training have ill-prepared them to recognize. And some patients do indeed malinger, and it is important to identify them, if only to spare legitimately injured claimants from being tarred with the same brush. This paper describes some of the syndromes that may present in clinical and forensic practice with brain-injured patients. It is to be considered a first step toward a practice model of neuropsychology that encourages the role of knowledge and clinical judgement in guiding the meaningful clinical interpretation of tests and measures.

Brain Concussion↗
PubMed2003

Detecting neuropsychological malingering: effects of coaching and information.

Concerns that patients presenting for neuropsychological assessment may not be putting forth maximum effort during testing has prompted the development of measures designed to detect malingering and incomplete effort. Two of these measures are the Computerized Assessment of Response Bias-97 (CARB-97) and Word Memory Test (WMT). Despite widespread use of these instruments, no study has been published determining the vulnerability of neuropsychological malingering measures to explicit coaching or brain injury information. The present study, using analog participants, found that the CARB-97 and WMT differentiate "normal" from "malingered" instructional sets, and show little difference between nai;ve and coached malingering efforts. There was also little difference between providing brain injury information and a no-information condition, but when effects were present, the information group generally scored worse. Further, it was found that response times (RTs), in addition to items correct, may also be effective in detecting those who are not giving their full effort.

Adolescent↗
PubMed2003

Quantitative measures of memory malingering on the Wechsler Memory Scale--Third edition in mild head injury litigants.

Wechsler Memory Scale-Third edition (WMS-III) performance in 25 mild traumatic brain injury (TBI) litigants who met the criteria for probable malingered neurocognitive dysfunction (MND) was compared with 50 nonmalingering subjects. The base rate for probable MND in the population studied was 27%. Overall, malingerers showed globally depressed memory function. They returned significantly poorer scores than nonmalingerers on all WMS-III indexes and subtests, and on selected WMS-III index difference scores and intelligence-memory difference scores. Using the minimum score returned in the nonmalingerers as the cut-off for malingering, the delayed auditory recognition memory tasks were highly effective in detecting malingering. Raw scores below 43 on the auditory recognition-delayed (AR-D) subtest or below 18 on word list II-recognition, identified around 80% of the malingerers. In a group of 50 severe TBI litigants, only a very small proportion (i.e., <10%) returned scores below the cut-offs for malingering for the mild TBI subjects.

Adolescent↗
PubMed2003

Use of the CBDI to detect malingering when malingerers do their "homework".

Previous research has demonstrated the ability of the Cognitive Behavioral Driver's Inventory (CBDI) to detect neuropsychological malingering [Arch. Clin. Neuropsychol. 12 (5) (1997) 491.], however, the present study tests if the CBDI can discern malingerers when they are "coached" on how brain-damaged patients actually perform on neuropsychological tests. Ninety-eight college student participants were given financial incentive to fake brain damage on the CBDI. Fifty-three of these subjects were "coached" and 45 were not. The coached and uncoached subjects performed indistinguishably on the CBDI. Both types of malingerers were discernable from real brain-damaged patients (99.2% accuracy area under the sensitivity-specificity curve). Further, CBDI profiles of five actual plaintiffs judged to be malingering were compared to CBDI profiles of experimental subjects. In each case, the malingering plaintiff's CBDI profile was indistinguishable from that of malingering experimental subjects and was clearly discernable from that of actual brain-damaged patients.

Adult↗
PubMed2003

Partial cross-validation of the Wechsler Memory Scale-Revised (WMS-R) General Memory-Attention/Concentration Malingering Index in a nonlitigating sample.

The Wechsler Memory Scale-Revised (WMS-R) malingering indices proposed by Mittenberg, Azrin, Millsaps, and Heilbronner [Psychol Assess 5 (1993) 34.] were partially cross-validated in a sample of 200 nonlitigants. Nine diagnostic categories were examined, including participants with traumatic brain injury (TBI), brain tumor, stroke/vascular, senile dementia of the Alzheimer's type (SDAT), epilepsy, depression/anxiety, medical problems, and no diagnosis. Results showed that the discriminant function using WMS-R subtests misclassified only 6.5% of the sample as malingering, with significantly higher misclassification rates of SDAT and stroke/vascular groups. The General Memory Index-Attention/Concentration Index (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering when a difference score of greater than 25 points was used as the cutoff criterion. No diagnostic group was significantly more likely to be misclassified. Results support the utility of the GMI-ACI difference score, as well as the WMS-R subtest discriminant function score, in detecting malingering.

Adult↗
PubMed2004

The effects of motivation, coaching, and knowledge of neuropsychology on the simulated malingering of head injury.

Two student groups, introductory psychology (n=91) and advanced neuroscience (n=34) undergraduates, were asked to malinger a head injury on Rey's 15-Item Test (FIT) and Dot Counting Test (DCT). The participants were randomly assigned to one of three motivation conditions (no motivation given, compensation, avoidance of blame for a motor vehicle accident) and to one of three coaching conditions (no coaching, coaching post-concussive symptoms, coaching symptoms plus warning of malingering detection). Analyses revealed a MotivationxStudent Group interaction on the FIT, indicating that the advanced neuroscience students, particularly when in the compensation condition, malingered the most flagrantly. On the DCT, main effects for motivation and coaching on the qualitative variables and a MotivationxCoaching interaction on the accuracy variables indicated that those in the compensation condition performed the most poorly, and that coaching plus warning only tempers malingering on memory tasks, not timed tasks.

Adult↗
PubMedDate not supplied

[Intelligence, memory and malingering: correlation between scales].

OBJECTIVES: To validate the test of memory malingering (TOMM), and to study the influence of intelligence and memory on its performance in brain injury patients. PATIENTS AND METHODS: A total of 30 patients with traumatic head injury were included in the study. All patients were assessed with the Complutense verbal learning test, the Visual Reproduction subtest of the Wechsler memory scale-revised, the Boston naming test, two fluency tests (FAS, and animals), the Wechsler adult intelligence test-III, and with the TOMM. Cognitive results below 1 standard deviation (SD) from normative data were considered 'abnormal'. A parametric correlation between TOMM scores and cognitive tests was used to detect whether memory and intelligence were affecting TOMM performance. Statistical significance was set up at p<0.05. RESULTS: Between 46.1% (Boston) and 81.4% (WAIS-III performance IQ) of the sample presented cognitive deficits. Up to 83.3% of the patients scored above the cutoff point suggestive of malingering in the TOMM (45/50). Significance correlations were found between TOMM scores and memory or intelligence indexes. DISCUSSION: The TOMM is a useful tool to detect malingering in head injured patients. Effects of low intelligence coefficients, as well as memory deficits should be considered in clinical practice when evaluating patients with TOMM scores suggestive of malingering.

Adolescent↗
PubMed1990

Development of a new classificatory model of malingering.

Inclusion criteria for the classification of malingering are shaped and largely predetermined by our explanatory theories. Current theories have postulated the motivation to malinger is either the product of underlying psychopathology (pathogenic model) or criminal backgrounds (DSM III-R model). I have proposed a third model that malingering is typically an adaptive response to adverse circumstances which may best be understood in the context of decision theory. Based on this approach I have argued that indices of malingering should be empirically derived and focused on clinical presentation. Finally, I have proposed a preliminary model for the classification of malingerers which combines clinical data with corroborative evidence.

Antisocial Personality Disorder↗
PubMed1996

Malingering a challenge for the forensic examiner.

After pointing out that spoken and non-verbal language are the primary means of communication in interpersonal dialogue, and especially in a forensic criminological examination, the authors present malingering in a legal context from an historical and psychodynamic- ontogenetic point of view. Diagnostic characteristics of malingering are reported in a review of previous studies. Latest psychological testing is presented. The authors express their professional opinion that malingering in a criminological forensic setting should be divested of the aura of deviousness and manipulation acquired throughout the past years. They propose that it is a defensive reaction to which a person charged with a crime resorts when under the stress of facing the legal consequences of wrongdoing. They view malingering in a forensic setting as regressive behavior to a childhood or adolescent stage, not to condone or justify it, but in an attempt to bring about better communication between examiner and examinee.

Adult↗
PubMed1997

The detection of simulated malingering using a computerized category classification test.

A category classification test was used to differentiate between normal student control participants, students instructed to malinger a memory deficit, and amnesic patients. Controls (N = 44) and amnesic patients (N = 10) were instructed to do their best, while simulators of malingering (N = 43) were instructed to fake a memory deficit for credit and possible financial compensation. Participants studied a list of high distortions of a prototype dot pattern and were then asked to choose whether or not a new set of dot patterns (random patterns, high distortions, low distortions, and the prototype) belonged to the same category of dot patterns as studied. Malingerers performed significantly worse than normal controls and amnesic patients. A discriminant function analysis showed that the classification test can be used to correctly classify participants as simulated malingerers, controls, or amnesic patients significantly higher than chance. These results indicate that a category classification test can be used in the detection of simulated malingering and that some tests of implicit memory provide a potential supplement to standard forced choice tests in the detection of malingering.

Journal Article↗
PubMed1997

Malingering detection with the dot counting test.

The Dot Counting Test (DCT) offers a technique for malingering detection that is less transparent than the forced-choice testing that has received so much recent attention. The present study defined six dependent variables derived from DCT responses, and examined these variables in the context of differentiating simulators from non-simulators. Four groups of subjects were studied: normal controls, neuropsychological evaluation patients, naive (uncoached) malingering simulators, and sophisticated (coached) malingering simulators. Results demonstrate that the DCT provides several different scores that significantly differ between simulators and non-simulators. The DCT appears to hold promise as an additional tool to neuropsychologists in the detection of malingering.

Journal Article↗
PubMed1995

Malingering response styles on the memory assessment scales and symptom validity tests.

This study identified malingering strategies of test performance and investigated their presence in the responses to computer-mediated versions of Rey's Dot-Counting and 15-Items tests, a forced-choice symptom validity procedure and the Memory Assessment Scales (MAS). Sixty volunteer subjects were randomly assigned to control (n = 30) or malingering (n = 30) groups. The control subjects were instructed to perform their best and the malingerers were instructed to fake a poor performance on the tests. As expected, malingering subjects scored significantly worse than control subjects on virtually all tests. Malingerers had slower response times on most tests. They also performed worse on recognition tasks in contrast to performance on recall tasks. Their response style was characterized by intentional wrong and random responding on recognition tasks. Malingerers did not show the expected worse-than-chance responding on the forced-choice symptom validity procedure. Current tests of symptom validity may not have sufficient sensitivity to detect milder forms of malingering.

Clinical Trial↗
PubMed1999

Serial malingering on verbal and nonverbal fluency and memory measures: an analog investigation.

Analysis of response consistency on neuropsychological test performance, both within and across testing sessions, can be an important method of detecting malingering. Little systematic research, however, has examined how suspected malingerers perform across repeat evaluations, a common forensic occurrence. To address this issue, we examined performance across a 3-week interval in an analogue malingering design on the California Verbal Learning Test (CVLT), the Rey Complex Figure, the Controlled Oral Word Association Test, and the Ruff Figural Fluency Test. Malingering simulators (n = 21) performed more poorly on all measures than the controls (n = 21) and demonstrated practice effects on the nonverbal, but not the verbal, tests. Controls demonstrated practice effects on all measures across time. Contrary to hypotheses, malingering simulators demonstrated high and similar levels of between and within time consistency as controls when assessed via a series of correlations. Despite this consistency, when qualitative performance patterns were assessed on the CVLT, simulators were less likely to consistently recall the same word across successive learning trials. The following issues are discussed: (a) the differential pattern of practice effects on verbal and nonverbal tasks, (b) qualitative and quantitative differences in assessment of consistency, and (c) how future research should study consistency/inconsistency.

Journal Article↗
PubMed1997

Performance of substance abusers with memory deficits on measures of malingering.

The effects of memory impairment on various malingering indices were assessed in a substance abusing population. Groups were formed by using scores from the Delayed Memory Index of the Wechsler Memory Scale-Revised and selecting individuals from an addictions recovery unit in the top and bottom quintiles. Quintile group differences were found for number correct on free and forced-choice recall on the 21-Item Wordlist; total time for grouped and ungrouped dots on the Rey Dot Counting procedure; and addition errors on the Memorization of 16 Items test. All differences found were in the direction of better performance by subjects with better Delayed Memory Index scores; however, all of the differences were small. With the exception of the free recall index from the 21-Item Wordlist, all subjects had scores on the malingering measures beyond the cutoffs typically used to detect malingering in clinical populations. These findings suggest that, even in memory-impaired populations, memory measures of malingering are valid.

Journal Article↗