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Gonzalez C, Finley JCA, Khalid E, Basurto KS, VanLandingham HB, Frick LA, Brooks JM, Ellison RL, Ulrich DM, Soble JR, Resch ZJ. The Impact of Adverse Childhood Experiences on Symptom and Performance Validity Tests Among a Multiracial Sample Presenting for ADHD Evaluation. Arch Clin Neuropsychol 2024:acae006. [PMID: 38366222 DOI: 10.1093/arclin/acae006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) are commonly reported in individuals presenting for attention-deficit hyperactivity disorder (ADHD) evaluation. Performance validity tests (PVTs) and symptom validity tests (SVTs) are essential to ADHD evaluations in young adults, but extant research suggests that those who report ACEs may be inaccurately classified as invalid on these measures. The current study aimed to assess the degree to which ACE exposure differentiated PVT and SVT performance and ADHD symptom reporting in a multi-racial sample of adults presenting for ADHD evaluation. METHOD This study included 170 adults referred for outpatient neuropsychological ADHD evaluation who completed the ACE Checklist and a neurocognitive battery that included multiple PVTs and SVTs. Analysis of variance was used to examine differences in PVT and SVT performance among those with high (≥4) and low (≤3) reported ACEs. RESULTS Main effects of the ACE group were observed, such that high ACE group reporting demonstrated higher scores on SVTs assessing ADHD symptom over-reporting and infrequent psychiatric and somatic symptoms on the Minnesota Multiphasic Personality Inventory-2-Restructured Form. Conversely, no significant differences emerged in total PVT failures across ACE groups. CONCLUSIONS Those with high ACE exposure were more likely to have higher scores on SVTs assessing over-reporting and infrequent responses. In contrast, ACE exposure did not affect PVT performance. Thus, ACE exposure should be considered specifically when evaluating SVT performance in the context of ADHD evaluations, and more work is needed to understand factors that contribute to different patterns of symptom reporting as a function of ACE exposure.
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Affiliation(s)
- Christopher Gonzalez
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - John-Christopher A Finley
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elmma Khalid
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Karen S Basurto
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Hannah B VanLandingham
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Lauren A Frick
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, Wheaton College, Wheaton, IL, USA
| | - Julia M Brooks
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Rachael L Ellison
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Devin M Ulrich
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Jason R Soble
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Zachary J Resch
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, USA
- Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
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2
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Silverberg ND, Rush BK. Neuropsychological evaluation of functional cognitive disorder: A narrative review. Clin Neuropsychol 2024; 38:302-325. [PMID: 37369579 DOI: 10.1080/13854046.2023.2228527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023]
Abstract
Objective: To critically review contemporary theoretical models, diagnostic approaches, clinical features, and assessment findings in Functional Cognitive Disorder (FCD), and make recommendations for neuropsychological evaluation of this condition. Method: Narrative review. Results: FCD is common in neuropsychological practice. It is characterized by cognitive symptoms that are not better explained by another medical or psychiatric disorder. The cognitive symptoms are associated with distress and/or limitations in daily functioning, but are potentially reversible with appropriate identification and treatment. Historically, a variety of diagnostic frameworks have attempted to capture this condition. A contemporary conceptualization of FCD positions it as a subtype of Functional Neurological Disorder, with shared and unique etiological factors. Patients with FCD tend to perform normally on neuropsychological testing or demonstrate relatively weak memory acquisition (e.g. list learning trials) in comparison to strong attention and delayed recall performance. Careful history-taking and behavioral observations are essential to support the diagnosis of FCD. Areas of ongoing controversy include operationalizing "internal inconsistencies" and the role of performance validity testing. Evidence for targeted interventions remains scarce. Conclusions: Neuropsychologists familiar with FCD can uniquely contribute to the care of patients with this condition by improving diagnostic clarity, richening case formulation, communicating effectively with referrers, and leading clinical management. Further research is needed to refine diagnosis, prognosis, and treatment.
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Djavad Mowafaghian Centre for Brain Health, Vancouver, British Columbia, Canada
| | - Beth K Rush
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida, USA
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3
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Bosso T, Vischia F, Keller R, Vai D, Imperiale D, Vercelli A. A case report and literature review of cognitive malingering and psychopathology. Front Psychiatry 2022; 13:981475. [PMID: 36311526 PMCID: PMC9613951 DOI: 10.3389/fpsyt.2022.981475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022] Open
Abstract
Malingering of cognitive difficulties constitutes a major issue in psychiatric forensic settings. Here, we present a selective literature review related to the topic of cognitive malingering, psychopathology and their possible connections. Furthermore, we report a single case study of a 60-year-old man with a long and ongoing judicial history who exhibits a suspicious multi-domain neurocognitive disorder with significant reduction of autonomy in daily living, alongside a longtime history of depressive symptoms. Building on this, we suggest the importance of evaluating malingering conditions through both psychiatric and neuropsychological assessment tools. More specifically, the use of Performance Validity Tests (PVTs)-commonly but not quite correctly considered as tests of "malingering"-alongside the collection of clinical history and the use of routine psychometric testing, seems to be crucial in order to detect discrepancies between self-reported patient's symptoms, embedded validity indicators and psychometric results.
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Affiliation(s)
- Tea Bosso
- Department of Psychology, University of Turin, Turin, Italy
| | - Flavio Vischia
- Cognitive Disorders Diagnosis and Treatment Centre, North-West Unit Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Roberto Keller
- Mental Health Department North-West Unit, Local Health Unit, ASL Città di Torino, Turin, Italy
| | - Daniela Vai
- Cognitive Disorders Diagnosis and Treatment Centre, North-West Unit Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Daniele Imperiale
- Cognitive Disorders Diagnosis and Treatment Centre, North-West Unit Amedeo di Savoia Hospital, ASL Città di Torino, Turin, Italy
| | - Alessandro Vercelli
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
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Holcomb M, Pyne S, Cutler L, Oikle DA, Erdodi LA. Take Their Word for It: The Inventory of Problems Provides Valuable Information on Both Symptom and Performance Validity. J Pers Assess 2022:1-11. [PMID: 36041087 DOI: 10.1080/00223891.2022.2114358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
This study was designed to compare the validity of the Inventory of Problems (IOP-29) and its newly developed memory module (IOP-M) in 150 patients clinically referred for neuropsychological assessment. Criterion groups were psychometrically derived based on established performance and symptom validity tests (PVTs and SVTs). The criterion-related validity of the IOP-29 was compared to that of the Negative Impression Management scale of the Personality Assessment Inventory (NIMPAI) and the criterion-related validity of the IOP-M was compared to that of Trial-1 on the Test of Memory Malingering (TOMM-1). The IOP-29 correlated significantly more strongly (z = 2.50, p = .01) with criterion PVTs than the NIMPAI (rIOP-29 = .34; rNIM-PAI = .06), generating similar overall correct classification values (OCCIOP-29: 79-81%; OCCNIM-PAI: 71-79%). Similarly, the IOP-M correlated significantly more strongly (z = 2.26, p = .02) with criterion PVTs than the TOMM-1 (rIOP-M = .79; rTOMM-1 = .59), generating similar overall correct classification values (OCCIOP-M: 89-91%; OCCTOMM-1: 84-86%). Findings converge with the cumulative evidence that the IOP-29 and IOP-M are valuable additions to comprehensive neuropsychological batteries. Results also confirm that symptom and performance validity are distinct clinical constructs, and domain specificity should be considered while calibrating instruments.
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Affiliation(s)
| | | | - Laura Cutler
- Department of Psychology, Neuropsychology Track, University of Windsor
| | | | - Laszlo A Erdodi
- Department of Psychology, Neuropsychology Track, University of Windsor
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Young G. Interpreting symptom validity test fails in forensic disability and related assessments: When the cry for help for one fail makes sense. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-8. [PMID: 35940176 DOI: 10.1080/23279095.2022.2107929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Dandachi-FitzGerald et al. (2022), published the article "Cry for help as a root cause of poor symptom validity: A critical note," in Applied Neuropsychology: Adult [Advance Online], arguing that the cry for help in forensic disability and related assessments is not a valid interpretation for poor symptom validity test results. This rebuttal contests the criticisms of the use of the cry for help in this context, as presented in Young (2019); "The Cry for help in a psychological injury and law: Concepts and review" that appeared in Psychological Injury and Law, Vol. 12, pp. 225-237. It calls for more programmatic research, for example, based on the cry for help questionnaire suggested by the author. In particular, it indicates, for example, that one SVT test failure in a test battery constitutes an assessment result that could allow for attributing the cry for help, everything else being equal. It suggests that the adaptational theory explains the cry for help as much as malingering. It suggests practice and court recommendations that will allow better rebuttals of unethical assessors who overuse/misuse/abuse the cry for help interpretation of poor symptom validity test results in forensic disability and related assessments.
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Affiliation(s)
- Gerald Young
- Department of Psychology, Glendon College, York University, Toronto, Canada
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6
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Boskovic I, Akca AYE, Giromini L. Symptom coaching and symptom validity tests: An analog study using the structured inventory of malingered symptomatology, Self-Report Symptom Inventory, and Inventory of Problems-29. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-13. [PMID: 35414324 DOI: 10.1080/23279095.2022.2057856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this pilot and exploratory study, we tested the robustness of three self-report symptom validity tests (SVTs) to symptom coaching for depression, with and without additional information available on the Internet. Specifically, we divided our sample (N = 193) so that each subject received either the Structured Inventory of Malingered Symptomatology (SIMS; n = 64), the Self-Report Symptom Inventory (SRSI; n = 66), or the Inventory of Problems-29 (IOP-29; n = 63). Within each of the three subgroups, approximately one third of participants were instructed to respond honestly (Genuine Condition, nSIMS = 21; nSRSI = 24; nIOP-29 = 26) and approximately two-thirds were instructed to feign depression. One half of the feigners were presented with a vignette to increase their compliance with instructions and were given information about symptoms of depression (Coached Feigning, nSIMS = 25; nSRSI = 18; nIOP-29 = 21), and the other half were given the same vignette and information about symptoms of depression, plus two Internet links to review before completing the test (Internet-Coached Feigning, nSIMS = 18; nSRSI = 24; nIOP-29 = 16). Overall, the results showed that the genuine conditions yielded the lowest total scores on all three measures, while the two feigning conditions did not significantly differ from each other. Looking at the detection rates for all feigning participants, all three measures showed satisfactory results, with IOP-29 performing slightly better than SIMS and SIMS performing slightly better than SRSI. Internet-Coached Feigners scored slightly lower on all three measures than feigners who were coached without the Internet links. Taken together, the results of this preliminary and exploratory study suggest that all three SVTs examined are sensitive to feigned depression even in the presence of symptom coaching, both with and without additional Internet-based information.
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Affiliation(s)
- Irena Boskovic
- Forensic Psychology Section, Clinical Psychology Department, Erasmus School of Social and Behavioral Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Forensic Psychology Section, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Dandachi-FitzGerald B, Merckelbach H, Merten T. Cry for help as a root cause of poor symptom validity: A critical note. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-6. [PMID: 35196463 DOI: 10.1080/23279095.2022.2040025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
When patients fail symptom validity tests (SVTs) and/or performance validity tests (PVTs), their self-reported symptoms and test profiles are unreliable and cannot be taken for granted. There are many well-established causes of poor symptom validity and malingering is only of them. Some authors have proposed that a cry for help may underlie poor symptom validity. In this commentary, we argue that cry for help is a (1) metaphorical concept that is (2) difficult to operationalize and, at present, (3) impossible to falsify. We conclude that clinicians or forensic experts should not invoke cry for help as an explanation for poor symptom validity. To encourage conceptual clarity, we propose a tentative framework for explaining poor symptom validity.
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Affiliation(s)
| | - Harald Merckelbach
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Thomas Merten
- Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Giromini L, Young G, Sellbom M. Assessing Negative Response Bias Using Self-Report Measures: New Articles, New Issues. PSYCHOLOGICAL INJURY & LAW 2022. [DOI: 10.1007/s12207-022-09444-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractIn psychological injury and related forensic evaluations, two types of tests are commonly used to assess Negative Response Bias (NRB): Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs). SVTs assess the credibility of self-reported symptoms, whereas PVTs assess the credibility of observed performance on cognitive tasks. Compared to the large and ever-growing number of published PVTs, there are still relatively few validated self-report SVTs available to professionals for assessing symptom validity. In addition, while several studies have examined how to combine and integrate the results of multiple independent PVTs, there are few studies to date that have addressed the combination and integration of information obtained from multiple self-report SVTs. The Special Issue of Psychological Injury and Law introduced in this article aims to help fill these gaps in the literature by providing readers with detailed information about the convergent and incremental validity, strengths and weaknesses, and applicability of a number of selected measures of NRB under different conditions and in different assessment contexts. Each of the articles in this Special Issue focuses on a particular self-report SVT or set of SVTs and summarizes their conditions of use, strengths, weaknesses, and possible cut scores and relative hit rates. Here, we review the psychometric properties of the 19 selected SVTs and discuss their advantages and disadvantages. In addition, we make tentative proposals for the field to consider regarding the number of SVTs to be used in an assessment, the number of SVT failures required to invalidate test results, and the issue of redundancy when selecting multiple SVTs for an assessment.
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Examining Base Rates of Symptom Endorsement and the Roles of Sex and Depressive Symptoms on the Structured Inventory of Malingered Symptomology (SIMS) in a Non-clinical Population. PSYCHOLOGICAL INJURY & LAW 2022. [DOI: 10.1007/s12207-021-09439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Shura RD, Ord AS, Worthen MD. Structured Inventory of Malingered Symptomatology: a Psychometric Review. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09432-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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11
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Symptom and Performance Validity Assessment in European Countries: an Update. PSYCHOLOGICAL INJURY & LAW 2021; 15:116-127. [PMID: 34849185 PMCID: PMC8612718 DOI: 10.1007/s12207-021-09436-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/13/2021] [Indexed: 11/23/2022]
Abstract
In 2013, a special issue of the Spanish journal Clínica y Salud published a review on symptom and performance validity assessment in European countries (Merten et al. in Clínica y Salud, 24(3), 129–138, 2013). At that time, developments were judged to be in their infancy in many countries, with major publication activities stemming from only four countries: Spain, The Netherlands, Great Britain, and Germany. As an introduction to a special issue of Psychological Injury and Law, this is an updated report of developments during the last 10 years. In that period of time, research activities have reached a level where it is difficult to follow all developments; some validity measures were newly developed, others were adapted for European languages, and validity assessment has found a much stronger place in real-world evaluation contexts. Next to an update from the four nations mentioned above, reports are now given from Austria, Italy, and Switzerland, too.
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12
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The Call for Aid (Cry for Help) in Psychological Injury and Law: Reinterpretation, Mechanisms, and a Call for Research. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09414-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Sabelli AG, Messa I, Giromini L, Lichtenstein JD, May N, Erdodi LA. Symptom Versus Performance Validity in Patients with Mild TBI: Independent Sources of Non-credible Responding. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09400-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Boskovic I, Zwaan L, Baillie V, Merckelbach H. Consistency does not aid detection of feigned symptoms, overreporting does: Two explorative studies on symptom stability among truth tellers and feigners. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1458-1466. [PMID: 33761304 DOI: 10.1080/23279095.2021.1888728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Practitioners always want to exclude the possibility that a patient is feigning symptoms. Some experts have suggested that an inconsistent symptom presentation across time (i.e., intraindividual variability) is indicative of feigning. We investigated how individuals with genuine pain-related symptoms (truth tellers; Study 1 n = 32; Study 2 n = 48) and people feigning such complaints (feigners; Study 1 n = 32; Study 2 n = 28) rated the intensity of their symptoms across a 5-day period. In both studies, feigners reported on all 5 days significantly higher symptom intensities than people with genuine complaints, but the two groups did not differ with regard to symptom (in)consistency. Thus, persistently inflated, rather than inconsistent, reports of symptom intensity over time are suggestive of feigning. The implications and limitations of our work are discussed.
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Affiliation(s)
- Irena Boskovic
- Faculty of Psychology and Neuroscience, Forensic Psychology section, Maastricht University, Maastricht, The Netherlands.,Erasmus School of Social and Behavioural Sciences, Clinical Psychology department, Forensic Psychology section, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Lisette Zwaan
- Faculty of Psychology and Neuroscience, Forensic Psychology section, Maastricht University, Maastricht, The Netherlands.,Erasmus School of Social and Behavioural Sciences, Clinical Psychology department, Forensic Psychology section, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Victoria Baillie
- Faculty of Psychology and Neuroscience, Forensic Psychology section, Maastricht University, Maastricht, The Netherlands
| | - Harald Merckelbach
- Faculty of Psychology and Neuroscience, Forensic Psychology section, Maastricht University, Maastricht, The Netherlands
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Carvalho LDF, Reis A, Colombarolli MS, Pasian SR, Miguel FK, Erdodi LA, Viglione DJ, Giromini L. Discriminating Feigned from Credible PTSD Symptoms: a Validation of a Brazilian Version of the Inventory of Problems-29 (IOP-29). PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09403-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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The Eggshell and Crumbling Skull Plaintiff: Psychological and Legal Considerations for Assessment. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09392-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Miskey HM, Martindale SL, Shura RD, Taber KH. Distress Tolerance and Symptom Severity as Mediators of Symptom Validity Failure in Veterans With PTSD. J Neuropsychiatry Clin Neurosci 2020; 32:161-167. [PMID: 31266409 DOI: 10.1176/appi.neuropsych.17110340] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Performance validity tests (PVTs) and symptom validity tests (SVTs) are necessary in clinical and research contexts. The extent to which psychiatric distress contributes to failure on these tests is unclear. The authors hypothesized that the relation between posttraumatic stress disorder (PTSD) and validity would be serially mediated by distress tolerance and symptom severity. METHODS Participants included 306 veterans, 110 of whom met full criteria for current PTSD. PVTs included the Medical Symptom Validity Test (MSVT) and b Test. The Structured Inventory of Malingered Symptomatology (SIMS) was used to measure symptom validity. RESULTS MSVT failure was significantly and directly associated with PTSD severity (B=0.05, CI=0.01, 0.08) but not distress tolerance or PTSD diagnosis. b Test performance was not significantly related to any variable. SIMS failure was significantly associated with PTSD diagnosis (B=0.71, CI=0.05, 1.37), distress tolerance (B=-0.04, CI=-0.07, -0.01), and symptom severity (B=0.07, CI=0.04, 0.09). The serial mediation model significantly predicted all SIMS subscales. CONCLUSIONS PTSD severity was associated with failing a memory-based PVT but not an attention-based PVT. Neither PVT was associated with distress tolerance or PTSD diagnosis. SVT failure was associated with PTSD diagnosis, poor distress tolerance, and high symptomatology. For veterans with PTSD, difficulty managing negative emotional states may contribute to symptom overreporting. This may reflect exaggeration or an inability to tolerate stronger negative affect, rather than a "cry for help."
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Affiliation(s)
- Holly M Miskey
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
| | - Sarah L Martindale
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
| | - Robert D Shura
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
| | - Katherine H Taber
- The Salisbury Veterans Affairs Health Care System, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); the Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Salisbury, N.C. (Miskey, Martindale, Shura, Taber); and the Wake Forest School of Medicine, Winston-Salem, N.C. (Miskey, Martindale, Shura)
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Sherman EMS, Slick DJ, Iverson GL. Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria. Arch Clin Neuropsychol 2020; 35:735-764. [PMID: 32377667 PMCID: PMC7452950 DOI: 10.1093/arclin/acaa019] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Empirically informed neuropsychological opinion is critical for determining whether cognitive deficits and symptoms are legitimate, particularly in settings where there are significant external incentives for successful malingering. The Slick, Sherman, and Iversion (1999) criteria for malingered neurocognitive dysfunction (MND) are considered a major milestone in the field's operationalization of neurocognitive malingering and have strongly influenced the development of malingering detection methods, including serving as the criterion of malingering in the validation of several performance validity tests (PVTs) and symptom validity tests (SVTs) (Slick, D.J., Sherman, E.M.S., & Iverson, G. L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13(4), 545-561). However, the MND criteria are long overdue for revision to address advances in malingering research and to address limitations identified by experts in the field. METHOD The MND criteria were critically reviewed, updated with reference to research on malingering, and expanded to address other forms of malingering pertinent to neuropsychological evaluation such as exaggeration of self-reported somatic and psychiatric symptoms. RESULTS The new proposed criteria simplify diagnostic categories, expand and clarify external incentives, more clearly define the role of compelling inconsistencies, address issues concerning PVTs and SVTs (i.e., number administered, false positives, and redundancy), better define the role of SVTs and of marked discrepancies indicative of malingering, and most importantly, clearly define exclusionary criteria based on the last two decades of research on malingering in neuropsychology. Lastly, the new criteria provide specifiers to better describe clinical presentations for use in neuropsychological assessment. CONCLUSIONS The proposed multidimensional malingering criteria that define cognitive, somatic, and psychiatric malingering for use in neuropsychological assessment are presented.
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Affiliation(s)
| | | | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
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Abeare CA, Hurtubise JL, Cutler L, Sirianni C, Brantuo M, Makhzoum N, Erdodi LA. Introducing a forced choice recognition trial to the Hopkins Verbal Learning Test – Revised. Clin Neuropsychol 2020; 35:1442-1470. [DOI: 10.1080/13854046.2020.1779348] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | - Laura Cutler
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | | | - Maame Brantuo
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Nadeen Makhzoum
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Laszlo A. Erdodi
- Department of Psychology, University of Windsor, Windsor, ON, Canada
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Verifiability and Symptom Endorsement in Genuine, Exaggerated, and Malingered Pain. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09375-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AbstractThe current study has investigated whether pure malingering, in which reported symptoms are nonexistent, partial malingering, in which existent symptoms are exaggerated, and genuine symptoms could be differentiated by applying the verifiability approach (VA) and the Self-Report Symptom Inventory (SRSI). The logic behind the VA is that deceivers’ statements contain more non-verifiable information, whereas truth tellers’ accounts include more verifiable details. The SRSI taps into over-reporting by including a mix of genuine symptoms and implausible complaints (pseudosymptoms). We checked if participants (N = 167) allocated to one of three conditions (pure malingerers vs. exaggerators vs. truth tellers) can be differentiated in their pain symptom reports’ (non)verifiability and symptom endorsement. Findings revealed that deceptive reports were lengthier than truthful statements. However, this difference was not produced by a discrepancy in non-verifiable details, but rather by a higher production of verifiable information among malingerers and exaggerators. Thus, contrary to previous findings, our results indicate that pain reports rich in verifiable information should raise doubt about their veracity. Further, truth tellers endorsed less symptoms of the SRSI than exaggerators, but not than pure malingerers. Pure malingerers and exaggerators did not differ in symptom endorsement. Thus, our findings revealed that when compared with truth tellers, exaggerators exhibited stronger over-reporting tendencies than (pure) malingerers. However, due to inconsistent findings, further investigation of the efficacy of these methods in differentiation between exaggerated and malingered reports is required.
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Schmidt T, Krüger M, Ullmann U. [Base Rate of Probable Malingering and its Indicators in the Assessment of Mental Disorders - Retrospective Analysis of a Sample of Forensic Psychological Evaluations]. REHABILITATION 2020; 59:231-236. [PMID: 32252123 DOI: 10.1055/a-1122-5233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Estimation of a base rate of malingering in accordance with changes of the complexity of assessment in a sample of forensic psychological evaluations. METHODS We performed a retrospective analysis of 1175 psychological evaluations over the course of 16 years (2000-2015). RESULTS With the use of increasingly complex methods, inconsistencies are reported more frequently and a higher rate of feigning (47,2%) in symptom validity testing is noted. However, the overall rate of malingering is only 15,8%. A uniform multi-methods approach guarantees that there does not develop any bias in the assessment across evaluators. CONCLUSION The revealed rate of malingering matches recent reviews that call into question estimations which had yielded substantially higher rates. Symptom validity tests serve as an important decision-making tool for psychological evaluators. For the overall assessment, however, other possible inconsistencies are taken into account.
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Affiliation(s)
- Thomas Schmidt
- Medizinische Psychologie, Klinik: BG-Klinikum Bergmannstrost Halle
| | - Martin Krüger
- Medizinische Psychologie, Klinik: BG-Klinikum Bergmannstrost Halle
| | - Utz Ullmann
- Medizinische Psychologie, Klinik: BG-Klinikum Bergmannstrost Halle
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22
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Olla P, Rykulski N, Hurtubise JL, Bartol S, Foote R, Cutler L, Abeare K, McVinnie N, Sabelli AG, Hastings M, Erdodi LA. Short-term effects of cannabis consumption on cognitive performance in medical cannabis patients. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:647-657. [PMID: 31790276 DOI: 10.1080/23279095.2019.1681424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
This observational study examined the acute cognitive effects of cannabis. We hypothesized that cognitive performance would be negatively affected by acute cannabis intoxication. Twenty-two medical cannabis patients from Southwestern Ontario completed the study. The majority (n = 13) were male. Mean age was 36.0 years, and mean level of education was 13.7 years. Participants were administered the same brief neurocognitive battery three times during a six-hour period: at baseline ("Baseline"), once after they consumed a 20% THC cannabis product ("THC"), and once again several hours later ("Recovery"). The average self-reported level of cannabis intoxication prior to the second assessment (i.e., during THC) was 5.1 out of 10. Contrary to expectations, performance on neuropsychological tests remained stable or even improved during the acute intoxication stage (THC; d: .49-.65, medium effect), and continued to increase during Recovery (d: .45-.77, medium-large effect). Interestingly, the failure rate on performance validity indicators increased during THC. Contrary to our hypothesis, there was no psychometric evidence for a decline in cognitive ability following THC intoxication. There are several possible explanations for this finding but, in the absence of a control group, no definitive conclusion can be reached at this time.
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Affiliation(s)
| | - Nicholas Rykulski
- College of Human Medicine, Michigan State University, Lansing, MI, USA
| | | | - Stephen Bartol
- School of Medicine, Wayne State University, Detroit, MI, USA
| | | | - Laura Cutler
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Kaitlyn Abeare
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Nora McVinnie
- Brain-Cognition-Neuroscience Program, University of Windsor, Windsor, ON, Canada
| | - Alana G Sabelli
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Maurissa Hastings
- Department of Psychology, University of Windsor, Windsor, ON, Canada
| | - Laszlo A Erdodi
- Department of Psychology, University of Windsor, Windsor, ON, Canada
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Merten T, Kaminski A, Pfeiffer W. Prevalence of overreporting on symptom validity tests in a large sample of psychosomatic rehabilitation inpatients. Clin Neuropsychol 2019; 34:1004-1024. [PMID: 31775575 DOI: 10.1080/13854046.2019.1694073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Noncredible symptom claims, regularly expected in forensic contexts, may also occur in clinical and rehabilitation referral contexts. Hidden motives and secondary gain expectations may play a significant role in clinical patients. We studied the prevalence of noncredible symptom report in patients treated for minor mental disorders in an inpatient setting.Method: Five hundred and thirty seven clinical inpatients of a psychosomatic rehabilitation center were studied (mean age: 50.2 years; native speakers of German). They were referred for treatment of depression, anxiety, somatoform disorder, adjustment disorder, and neurasthenia. Results of two symptom validity tests (Structured Inventory of Malingered Symptomatology, SIMS; Self-Report Symptom Inventory, SRSI) and the Beck Depression Inventory-II (BDI-II) were analyzed.Results: At screening level, 34.5% and 29.8% of the patients were found to presumably overreport symptoms on the SIMS and SRSI, respectively. At the standard cut score of the SRSI (maximum false positive rate: 5%), the proportion of diagnosed overreporting was 18.8%. SIMS and SRSI pseudosymptom endorsement correlated at .73. Highly elevated depressive symptom claims with BDI-II scores above 40, found in 9.3% of the patients, were associated with elevated pseudosymptom endorsement. Moreover, extended times of sick leave and higher expectations of disability pension were associated with elevated pseudosymptom endorsement.Conclusions: The prevalence of symptom overreporting in some clinical patient groups is a serious, yet underinvestigated problem. The current estimates yielded a high prevalence of distorted, noncredible symptom claims in psychosomatic rehabilitation patients. The challenges arising to health professionals working in such settings are immense and need more consideration.
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Affiliation(s)
- Thomas Merten
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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25
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Zasler ND, Bender SD. Validity Assessment in Traumatic Brain Injury Impairment and Disability Evaluations. Phys Med Rehabil Clin N Am 2019; 30:621-636. [PMID: 31227137 DOI: 10.1016/j.pmr.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This article provides an overview of validity assessment in persons with traumatic brain injury including evaluation caveats. Specific discussion is provided on post-concussive disorders, malingering, examination techniques to assess for validity, response bias, effort and non-organic/functional presentations. Examinee and examiner biases issues will also be explored. Discussion is also provided regarding judicial trends in limiting examiner scope of testing and/or testimony, and risk of liability when providing expert witness opinions on validity of examinee presentations. The hope is to encourage physiatrists to become more aware and skilled in validity assessment given its importance in differential diagnosis of impairment following traumatic brain injury.
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Affiliation(s)
- Nathan D Zasler
- Concussion Care Centre of Virginia, Ltd, Tree of Life Services, Inc, 3721 Westerre Parkway, Suite B, Richmond, VA 23233, USA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA, USA; Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, VA, USA; International Brain Injury Association, Alexandria, VA, USA.
| | - Scott D Bender
- Institute of law, psychiatry and Public policy, Department of Psychiatry and Neurobehavioral Science, University of Virginia, 1230 Cedars Court, Suite 108, Charlottesville, VA 22903, USA
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26
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Giger P, Merten T. Equivalence of the German and the French Versions of the Self-Report Symptom Inventory. SWISS JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1024/1421-0185/a000218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Abstract. Against the background of the growing importance of symptom validity assessment both in forensic and clinical or rehabilitation contexts, a new instrument for identifying overreporting was developed. In order to study the equivalence of the German and the French versions, we divided the item pool of the Self-Report Symptom Inventory (SRSI) into two presumably equivalent half-forms. A sample of 40 adult bilingual Swiss nationals with a mean age of 39.9 years responded honestly to one of the half-forms in German and to the other in French. In a subsequent experimental malingering condition, they were asked to simulate sequelae of a whiplash injury and to respond to the SRSI again. In both conditions, they also filled out the Structured Inventory of Malingered Symptomatology (SIMS). The results showed no differences between the two language versions in both conditions. Classification accuracy was very high (100% specificity, 90% sensitivity for the standard cutoff score). Reliability estimates were 0.93 for endorsement of genuine symptoms and 0.97 for pseudosymptom endorsement. In the malingering condition, the correlation between the number of reported pseudosymptoms and the SIMS scores was 0.69. The current results add to the database available for the SRSI and support the appropriateness of the French version.
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Affiliation(s)
- Peter Giger
- formerly Department of Defence, Civil Protection and Sport, Bern, Switzerland
| | - Thomas Merten
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Bodner T, Merten T, Benke T. Performance validity measures in clinical patients with aphasia. J Clin Exp Neuropsychol 2019; 41:476-483. [DOI: 10.1080/13803395.2019.1579783] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Thomas Bodner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Merten
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Thomas Benke
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Tonks J, Whitfield CK, Williams WH, Slater AM, Frampton IJ. "Must try harder." Is effort and performance validity testing a necessary part of pediatric neuropsychological assessment? APPLIED NEUROPSYCHOLOGY-CHILD 2018; 9:97-105. [PMID: 30583707 DOI: 10.1080/21622965.2018.1524766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Neuropsychological assessments results have significant implications for pediatric populations, based upon the assumption that the young person has adopted an effortful approach and has engaged in assessment. There is a commonly-accepted risk to assuming the validity of neuropsychological assessment results with adults, and, therefore, performance validity testing (PVT) has become a major topic of research and investigation and has become an accepted part of routine assessment. The same approach has not been adopted in assessment with children and a paucity of studies has focused on PVT in children. We review studies that demonstrate that children are equal to adults in their ability to use deception and that clinicians cannot detect false-effort without use of validity tests. We explore how frequently such tests are used and how well they work in assessment with children, and the limits, complexities, and constraints of adapting adult tests. We advocate that adequate performance validity testing is essential in order to maximize confidence in the results and we hypothesize that assessment with pediatric populations should take into account a range of influences, such as neuro-developmental factors associated with age of the child and suitability of proposed measures according to the evidence-base.
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Affiliation(s)
- James Tonks
- 1University of Exeter Medical School, Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Charlotte Katie Whitfield
- 2School of Psychology, Cardiff University, Cardiff, United Kingdom of Great Britain and Northern Ireland
| | - W Huw Williams
- 3School of Psychology, Washington Singer Laboratories, University of Exeter College of Life and Environmental Sciences, Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Alan M Slater
- School of Psychology, Washington Singer Laboratories, University of Exeter College of Life and Environmental Sciences, Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Ian J Frampton
- School of Psychology, Washington Singer Laboratories, University of Exeter College of Life and Environmental Sciences, Exeter, United Kingdom of Great Britain and Northern Ireland
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Abstract
Although exaggeration or amplification of symptoms is common in all illness, deliberate deception is rare. In settings associated with litigation/disability evaluation, the rate of malingering may be as high as 30%, but its frequency in clinical practice is not known. We describe the main characteristics of deliberate deception (factitious disorders and malingering) and ways that neurologists might detect symptom exaggeration. The key to establishing that the extent or severity of reported symptoms does not truly represent their severity is to elicit inconsistencies in different domains, but it is not possible to determine whether the reports are intentionally inaccurate. Neurological disorders where difficulty in determining the degree of willed exaggeration is most likely include functional weakness and movement disorders, post-concussional syndrome (or mild traumatic brain injury), psychogenic non-epileptic attacks and complex regional pain syndrome type 1 (especially when there is an associated functional movement disorder). Symptom amplification or even fabrication are more likely if the patient might gain benefit of some sort, not necessarily financial. Techniques to detect deception in medicolegal settings include covert surveillance and review of social media accounts. We also briefly describe specialised psychological tests designed to elicit effort from the patient.
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Affiliation(s)
- Christopher Bass
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford, UK
| | - Derick T Wade
- Nuffield Orthopaedic Hospital, Oxford Centre for Enablement, Oxford, UK
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30
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Geurten M, Meulemans T, Seron X. Detecting over-reporting of symptoms: the French version of the self-report symptom inventory. Clin Neuropsychol 2018; 32:164-181. [PMID: 30317913 DOI: 10.1080/13854046.2018.1524027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Symptom exaggeration and malingering are core issues in forensic and clinical evaluation. Generally, experts use two main types of instruments to assess the credibility of symptoms: performance validity tests that aim to detect underperformance and self-report validity tests that appraise over-reporting of symptoms. However, while many tools can be used to assess underperformance, far fewer instruments are available to evaluate over-reporting of symptoms. METHODS In this study, we adapted the Self-Report Symptom Inventory (SRSI) for use with French-speaking participants and tested its psychometric properties on a sample of 575 healthy adults (aged from 18 to 65 years), alongside various smaller subgroups. RESULTS Exploratory and confirmatory factor analyses supported a two-factor structure for the scale, with a first factor including items questioning genuine symptoms and a second factor including items questioning bizarre or rare symptoms (i.e., pseudosymptoms). Additional analyses emphasized the SRSI's excellent internal reliability and good convergent validity. Furthermore, our results revealed that both the symptom and pseudosymptom subscales were able to discriminate between participants who were asked to feign cognitive impairments (i.e., malingerers), healthy controls, and patients with genuine cognitive symptoms. CONCLUSION Overall, these results suggest that the SRSI may be considered a promising tool to assess the credibility of symptoms in patients evaluated in forensic contexts.
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Affiliation(s)
- Marie Geurten
- a Cyclotron Research Center, University of Liège , Liège , Belgium.,b Psychology and Neuroscience of Cognition Unit , University of Liège , Liège , Belgium
| | - Thierry Meulemans
- b Psychology and Neuroscience of Cognition Unit , University of Liège , Liège , Belgium
| | - Xavier Seron
- c Institut de Recherche en Sciences Psychologiques (IPSY), Centre de Neuroscience Système et Cognition (NeuroCS) , Université Catholique de Louvain , Louvain-la-Neuve , Belgium
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Merckelbach H, Prins C, Boskovic I, Niesten I, À Campo J. Alexithymia as a potential source of symptom over-reporting: An exploratory study in forensic patients and non-forensic participants. Scand J Psychol 2018; 59:192-197. [DOI: 10.1111/sjop.12427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 11/08/2017] [Indexed: 01/30/2023]
Affiliation(s)
- Harald Merckelbach
- Forensic Psychology; Faculty of Psychology and Neuroscience; Maastricht University; the Netherlands
| | - Chinouk Prins
- Forensic Psychology; Faculty of Psychology and Neuroscience; Maastricht University; the Netherlands
| | - Irena Boskovic
- Forensic Psychology; Faculty of Psychology and Neuroscience; Maastricht University; the Netherlands
| | - Isabella Niesten
- Forensic Psychology; Faculty of Psychology and Neuroscience; Maastricht University; the Netherlands
| | - Joost À Campo
- Radix Forensic Outpatient Clinic; Mondriaan; Heerlen the Netherlands
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Abstract
SummaryMalingering is the dishonest and intentional production of symptoms. It can cause considerable difficulty as assessment runs counter to normal practice, and it may expose clinicians to testing medicolegal situations. In this first part of a two-article review, we explore types of psychiatric malingering and their occurrence across a range of common and challenging scenarios, discussing presentations that may help delineate true from feigned illness. A framework is provided for undertaking an assessment where malingering is suspected, including recommendations on clinician approach, the use of collateral information, and self-evaluation of biases. The uses, and limitations, of psychometric tests are discussed, including ‘general’, malingering-specific and ‘symptom validity’ scales.Learning Objectives• Understand the challenges of determining ‘real’ from ‘malingered’ symptomatology across a range of psychiatric conditions• Have a rational strategy for approaching a clinical assessment where malingering is suspected• Appreciate the role and limitations of various psychometric tests that can be used in such assessments
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van Impelen A, Merckelbach H, Jelicic M, Niesten IJM, Campo JÀ. Differentiating Factitious from Malingered Symptomatology: the Development of a Psychometric Approach. PSYCHOLOGICAL INJURY & LAW 2017; 10:341-357. [PMID: 29299086 PMCID: PMC5740202 DOI: 10.1007/s12207-017-9301-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/17/2017] [Indexed: 11/27/2022]
Abstract
Psychometric symptom validity assessment is becoming increasingly part and parcel of psychological and neuropsychological assessments. An unresolved and rarely addressed issue concerns the differentiation between factitious and malingered symptom presentations: present-day symptom validity tests can assess whether an examinee presents with noncredible symptomatology, but not why an examinee does so. We explored this issue by developing the Symptom and Disposition Interview (SDI); a symptom validity test that incorporates strategies intended to gauge internal incentives associated with factitious disorder. The merits of the SDI were explored and compared to a traditional symptom validity test (the Structured Inventory of Malingered Symptomatology) in two analogue studies, each with factitious and malingering conditions (n = 24-30 per condition) and a clinical control group (n = 34, n = 40). Overall, the results were positive: The SDI was as effective in detecting feigned symptom presentations as a traditional symptom validity test and superior in differentiating factitious from malingered symptom presentations. We conclude that the SDI is not ready for clinical use, but that psychometric approaches to the assessment of factitious symptomatology, such as the SDI, appear sufficiently promising to warrant future research.
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Affiliation(s)
- Alfons van Impelen
- Forensic Psychology Section, Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Harald Merckelbach
- Forensic Psychology Section, Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Marko Jelicic
- Forensic Psychology Section, Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Isabella J. M. Niesten
- Forensic Psychology Section, Department of Clinical Psychological Science, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Joost à Campo
- Radix Forensic Psychiatric Hospital, Heerlen, The Netherlands
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Merten T. Logical Paradoxes and Paradoxical Constellations in Medicolegal Assessment. PSYCHOLOGICAL INJURY & LAW 2017. [DOI: 10.1007/s12207-017-9297-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Merten T, Rogers R. An International Perspective on Feigned Mental Disabilities: Conceptual Issues and Continuing Controversies. BEHAVIORAL SCIENCES & THE LAW 2017; 35:97-112. [PMID: 28276597 DOI: 10.1002/bsl.2274] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 06/06/2023]
Abstract
In forensic contexts, an increased prevalence of feigned symptom presentations should be expected, although it will probably vary by the context and specific forensic issue. Forensic experts should examine this possibility proactively while maintaining a balanced perspective that actively considers clinical data for both feigning and genuine responding. Psychological measures and standardized methods developed for feigning and other response styles can facilitate these often complex determinations. The current article provides an international perspective on the issue of feigned mental disabilities. In particular, important conceptual issues are discussed, such as the categorical versus dimensional approaches to feigning, and the advisability of well-defined rather than single-point cut scores for accuracy in clinical decision-making. Salient problems of differential diagnosis include a spectrum from malingering and factitious disorders to somatoform and conversion disorders. In rendering these important diagnostic distinctions, the questions of motivations and intentions remain key. However, the establishment of motivation cannot be facilely assumed from the context. Instead, forensic psychologists and psychiatrists bear the professional burden of carefully evaluating motivation and recognizing the clinical reality that sometimes the motivation in especially challenging cases may not be fully determined. Copyright © 2017 John Wiley & Sons, Ltd.
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Merckelbach H, Boskovic I, Pesy D, Dalsklev M, Lynn SJ. Symptom overreporting and dissociative experiences: A qualitative review. Conscious Cogn 2017; 49:132-144. [PMID: 28187372 DOI: 10.1016/j.concog.2017.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 10/05/2016] [Accepted: 01/23/2017] [Indexed: 02/07/2023]
Abstract
We discuss a phenomenon that has received little attention to date in research on dissociative phenomena, namely that self-reports of these phenomena overlap with the tendency to overendorse eccentric items. We review the literature documenting the dissociation-overreporting link and then briefly discuss various interpretations of this link: (1) overreporting is an artifact of measuring dissociative symptoms; (2) dissociative psychopathology engenders overreporting of eccentric symptoms through fantasy proneness or impairments in internal monitoring; (3) an overreporting response style as is evident in malingerers, for example, promotes reports of dissociative symptoms. These three interpretations are not mutually exclusive. Also, the dissociation-overreporting link may have different origins among different samples. Because overreporting may introduce noise in datasets, we need more research specifically aimed at disentangling the dissociation-overreporting link. We suggest various avenues to accomplish this goal.
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Affiliation(s)
- H Merckelbach
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands.
| | - I Boskovic
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - D Pesy
- Department of Neurology, Franziskus Hospital, Mönchengladbach, Germany
| | - M Dalsklev
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - S J Lynn
- Binghamton University - State University of New York, Binghamton, NY, USA
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Merckelbach H, Lynn SJ, Lilienfeld SO. Vissia and co-workers claim that DID is trauma-based. But how strong is their evidence? Acta Psychiatr Scand 2016; 134:559-560. [PMID: 27665210 DOI: 10.1111/acps.12642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- H Merckelbach
- Forensic Psychology Section, Maastricht University, Maastricht, the Netherlands
| | - S J Lynn
- Laboratory of Consciousness and Cognition, Psychology Department, Binghamton University, Binghamton, NY, USA
| | - S O Lilienfeld
- Department of Psychology, Emory University, Atlanta, GA, USA
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Kohutis EA. Assessing older adults in civil litigation cases. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:226-232. [PMID: 27810112 DOI: 10.1016/j.ijlp.2016.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With the population aging, the legal and mental health systems need to be prepared for cases that involve older adults beyond the customary matters of guardianship and competency. Assessing older adults with the current tests raises concerns because these measures may not be adequately normed for this age group. Malingering, factitious disorders, and somatoform disorders are discussed due to health-related issues of normal aging. These topics complicate the assessment procedure and need consideration because they may affect the claimant's performance or symptom presentation. Although claims of posttraumatic stress disorder (PTSD) are common in civil litigation cases, it can be additionally complex in older adults. The evaluator needs to weigh not only factors related to the normal biological process of aging but also those that are attendant with the litigation.
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van der Heide D, Merckelbach H. Validity of symptom reports of asylum seekers in a psychiatric hospital: A descriptive study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 49:40-46. [PMID: 27209603 DOI: 10.1016/j.ijlp.2016.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 05/09/2016] [Indexed: 06/05/2023]
Abstract
Our study involved three samples (N=85; N=38, and N=27) of asylum seekers in a Dutch psychiatric hospital. We looked at how often they reported severe dissociative episodes (i.e., not recognizing oneself in a mirror; seeing traumatic images in a mirror) and whether these symptoms were related to deviant performance on Symptom Validity Tests (SVTs), notably items from the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2005) and a forced-choice task modeled after the Morel Emotional Numbing Test (MENT; Morel, 1998). We also examined whether poor language proficiency and the presence of incentives to exaggerate symptoms might affect scores on SVTs. Dissociative target symptoms were reported by considerable percentages of patients (27-63%). Patients who reported these symptoms had significantly more often deviant scores on SVT items compared with those who did not report such symptoms. With a few exceptions, deviant scores on SVT items were associated with incentives rather than poor language skills. We conclude that the validity of self-reported symptoms in this target group should not be taken for granted and that SVTs may yield important information.
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Affiliation(s)
| | - Harald Merckelbach
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands.
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The Self-Report Symptom Inventory (SRSI): a New Instrument for the Assessment of Distorted Symptom Endorsement. PSYCHOLOGICAL INJURY & LAW 2016. [DOI: 10.1007/s12207-016-9257-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bass C, Halligan P. Factitious disorders and malingering in relation to functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:509-520. [PMID: 27719868 DOI: 10.1016/b978-0-12-801772-2.00042-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Interest in malingering has grown in recent years, and is reflected in the exponential increase in academic publications since 1990. Although malingering is more commonly detected in medicolegal practice, it is not an all-or-nothing presentation and moreover can vary in the extent of presentation. As a nonmedical disorder, the challenge for clinical practice remains that malingering by definition is intentional and deliberate. As such, clinical skills alone are often insufficient to detect it and we describe psychometric tests such as symptom validity tests and relevant nonmedical investigations. Finally, we describe those areas of neurologic practice where symptom exaggeration and deception are more likely to occur, e.g., postconcussional syndrome, psychogenic nonepileptic seizures, motor weakness and movement disorders, and chronic pain. Factitious disorders are rare in clinical practice and their detection depends largely on the level of clinical suspicion supported by the systematic collection of relevant information from a variety of sources. In this chapter we challenge the accepted DSM-5 definition of factitious disorder and suggest that the traditional glossaries have neglected the extent to which a person's reported symptoms can be considered a product of intentional choice or selective psychopathology largely beyond the subject's voluntary control, or more likely, both. We present evidence to suggest that neurologists preferentially diagnose factitious presentations in healthcare workers as "hysterical," possibly to avoid the stigma of simulated illness.
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Affiliation(s)
- C Bass
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford, UK.
| | - P Halligan
- School of Psychology, Cardiff University, Cardiff, UK
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Roor JJ, Dandachi-FitzGerald B, Ponds RWHM. A case of misdiagnosis of mild cognitive impairment: The utility of symptom validity testing in an outpatient memory clinic. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:172-8. [DOI: 10.1080/23279095.2015.1030018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeroen J. Roor
- Department of Medical Psychology, VieCuri Medical Centre, Venlo, The Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Brechje Dandachi-FitzGerald
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rudolf W. H. M. Ponds
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Niesten IJM, Nentjes L, Merckelbach H, Bernstein DP. Antisocial features and "faking bad": A critical note. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 41:34-42. [PMID: 25843907 DOI: 10.1016/j.ijlp.2015.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We critically review the literature on antisocial personality features and symptom fabrication (i.e., faking bad; e.g., malingering). A widespread assumption is that these constructs are intimately related. Some studies have, indeed, found that antisocial individuals score higher on instruments detecting faking bad, but others have been unable to replicate this pattern. In addition, studies exploring whether antisocial individuals are especially talented in faking bad have generally come up with null results. The notion of an intrinsic link between antisocial features and faking bad is difficult to test and research in this domain is sensitive to selection bias. We argue that research on faking bad would profit from further theoretical articulation. One topic that deserves scrutiny is how antisocial features affect the cognitive dissonance typically induced by faking bad. We illustrate our points with preliminary data and discuss their implications.
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Affiliation(s)
| | - Lieke Nentjes
- Forensic Psychology Section, Maastricht University, The Netherlands; Department of Clinical Psychology, University of Amsterdam, The Netherlands
| | | | - David P Bernstein
- Forensic Psychology Section, Maastricht University, The Netherlands; Forensic Psychiatric Center 'de Rooyse Wissel', The Netherlands
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Dandachi-FitzGerald B, Merten T, Ponds R, Niemann H. Europäische Umfrage zum Einsatz von Beschwerdenvalidierungstests: Ergebnisse der deutschen Teilnehmer. ZEITSCHRIFT FÜR NEUROPSYCHOLOGIE 2015. [DOI: 10.1024/1016-264x/a000135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zur Praxis der Beschwerdenvalidierung wurde 2011 eine Umfrage unter europäischen Neuropsychologen durchgeführt ( Dandachi-FitzGerald, Ponds & Merten, 2013 ). Die Ergebnisse der deutschsprachigen Teilstichprobe werden berichtet (n = 211). Obwohl die Teilnehmer die Bedeutung einer sorgfältigen Beurteilung der Beschwerdenvalidität anerkannten, dominieren nichtstandardisierte Ansätze. Die am häufigsten eingesetzten Beschwerdenvalidierungstests waren: Testbatterie zur Forensischen Neuropsychologie, Word Memory Test, Rey 15-Item-Test, Amsterdamer Kurzzeitgedächtnistest, Aggravations- und Simulationstest. Die Ergebnisse zeigen eine große Streuung bezüglich der Erwartungen über die Prävalenz negativer Antwortverzerrungen sowie zum Einsatz von Beschwerdenvalidierungstests. Erhebliche Unterschiede gab es in der Praxis der Beschwerdenvalidierung in gutachtlichen gegenüber klinischen Untersuchungskontexten. Leitlinien für die Beurteilung der Beschwerdenvalidität fehlen im deutschen Sprachraum und sind in Europa bislang nur aus Großbritannien bekannt.
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Affiliation(s)
| | | | - Rudolf Ponds
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Niederlande
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van Impelen A, Merckelbach H, Jelicic M, Merten T. The Structured Inventory of Malingered Symptomatology (SIMS): A Systematic Review and Meta-Analysis. Clin Neuropsychol 2014; 28:1336-65. [DOI: 10.1080/13854046.2014.984763] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Alfons van Impelen
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - Harald Merckelbach
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - Marko Jelicic
- Forensic Psychology Section, Maastricht University, Maastricht, The Netherlands
| | - Thomas Merten
- Department of Neurology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Bigler ED. Effort, symptom validity testing, performance validity testing and traumatic brain injury. Brain Inj 2014; 28:1623-38. [PMID: 25215453 PMCID: PMC4673569 DOI: 10.3109/02699052.2014.947627] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 05/09/2014] [Accepted: 07/20/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND To understand the neurocognitive effects of brain injury, valid neuropsychological test findings are paramount. REVIEW This review examines the research on what has been referred to a symptom validity testing (SVT). Above a designated cut-score signifies a 'passing' SVT performance which is likely the best indicator of valid neuropsychological test findings. Likewise, substantially below cut-point performance that nears chance or is at chance signifies invalid test performance. Significantly below chance is the sine qua non neuropsychological indicator for malingering. However, the interpretative problems with SVT performance below the cut-point yet far above chance are substantial, as pointed out in this review. This intermediate, border-zone performance on SVT measures is where substantial interpretative challenges exist. Case studies are used to highlight the many areas where additional research is needed. Historical perspectives are reviewed along with the neurobiology of effort. Reasons why performance validity testing (PVT) may be better than the SVT term are reviewed. CONCLUSIONS Advances in neuroimaging techniques may be key in better understanding the meaning of border zone SVT failure. The review demonstrates the problems with rigidity in interpretation with established cut-scores. A better understanding of how certain types of neurological, neuropsychiatric and/or even test conditions may affect SVT performance is needed.
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Affiliation(s)
- Erin D. Bigler
- Department of Psychology
- Neuroscience Center
- Magnetic Resonance Imaging Research Facility, Brigham Young University
Provo, UTUSA
- Department of Psychiatry
- The Brain Institute of Utah, University of Utah
Salt Lake City, UTUSA
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47
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Seron X. Lying in neuropsychology. Neurophysiol Clin 2014; 44:389-403. [PMID: 25306079 DOI: 10.1016/j.neucli.2014.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 01/22/2014] [Accepted: 04/12/2014] [Indexed: 11/29/2022] Open
Abstract
The issue of lying occurs in neuropsychology especially when examinations are conducted in a forensic context. When a subject intentionally either presents non-existent deficits or exaggerates their severity to obtain financial or material compensation, this behaviour is termed malingering. Malingering is discussed in the general framework of lying in psychology, and the different procedures used by neuropsychologists to evidence a lack of collaboration at examination are briefly presented and discussed. When a lack of collaboration is observed, specific emphasis is placed on the difficulty in unambiguously establishing that this results from the patient's voluntary decision.
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Affiliation(s)
- X Seron
- Université catholique de Louvain, institut de psychologie, 70, avenue du Cor-de-Chasse, 1170 Bruxelles, Belgium.
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Abstract
Compared with other psychiatric disorders, diagnosis of factitious disorders is rare, with identification largely dependent on the systematic collection of relevant information, including a detailed chronology and scrutiny of the patient's medical record. Management of such disorders ideally requires a team-based approach and close involvement of the primary care doctor. As deception is a key defining component of factitious disorders, diagnosis has important implications for young children, particularly when identified in women and health-care workers. Malingering is considered to be rare in clinical practice, whereas simulation of symptoms, motivated by financial rewards, is regarded as more common in medicolegal settings. Although psychometric investigations (eg, symptom validity testing) can inform the detection of illness deception, such tests need support from converging evidence sources, including detailed interview assessments, medical notes, and relevant non-medical investigations. A key challenge in any discussion of abnormal health-care-seeking behaviour is the extent to which a person's reported symptoms are considered to be a product of choice, or psychopathology beyond volitional control, or perhaps both. Clinical skills alone are not typically sufficient for diagnosis or to detect malingering. Medical education needs to provide doctors with the conceptual, developmental, and management frameworks to understand and deal with patients whose symptoms appear to be simulated. Central to the understanding of factitious disorders and malingering are the explanatory models and beliefs used to provide meaning for both patients and doctors. Future progress in management will benefit from an increased appreciation of the contribution of non-medical factors and a greater awareness of the conceptual and clinical findings from social neuroscience, occupational health, and clinical psychology.
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Affiliation(s)
- Christopher Bass
- Department of Psychological Medicine, John Radcliffe Hospital, Oxford, UK.
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Merckelbach H, Dandachi-FitzGerald B, van Mulken P, Ponds R, Niesten E. Exaggerating Psychopathology Produces Residual Effects That Are Resistant to Corrective Feedback: An Experimental Demonstration. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 22:16-22. [DOI: 10.1080/23279095.2013.816850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Harald Merckelbach
- a Forensic Psychology Section , Maastricht University , Maastricht , The Netherlands
| | | | - Peter van Mulken
- a Forensic Psychology Section , Maastricht University , Maastricht , The Netherlands
| | - Rudolf Ponds
- b School for Mental Health and Neuroscience , Maastricht University , Maastricht , The Netherlands
| | - Elly Niesten
- a Forensic Psychology Section , Maastricht University , Maastricht , The Netherlands
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50
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Simulation of multiple personalities: a review of research comparing diagnosed and simulated dissociative identity disorder. Clin Psychol Rev 2013; 34:14-28. [PMID: 24291657 DOI: 10.1016/j.cpr.2013.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 12/25/2022]
Abstract
Dissociative Identity Disorder (DID) has long been surrounded by controversy due to disagreement about its etiology and the validity of its associated phenomena. Researchers have conducted studies comparing people diagnosed with DID and people simulating DID in order to better understand the disorder. The current research presents a systematic review of this DID simulation research. The literature consists of 20 studies and contains several replicated findings. Replicated differences between the groups include symptom presentation, identity presentation, and cognitive processing deficits. Replicated similarities between the groups include interidentity transfer of information as shown by measures of recall, recognition, and priming. Despite some consistent findings, this research literature is hindered by methodological flaws that reduce experimental validity.
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