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Roor JJ, Dandachi-FitzGerald B, Peters MJV, Ponds RWHM. Providing a brief corrective statement does not improve test performance in patients invalidating testing: A multisite, single-blind randomized controlled trial. Clin Neuropsychol 2024:1-23. [PMID: 39056491 DOI: 10.1080/13854046.2024.2382340] [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: 03/18/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Abstract
Objective: Performance below the actual abilities of the examinee can be measured using performance validity tests (PVTs). PVT failure negatively impacts the quality of the neuropsychological assessment. In our study, we addressed this issue by providing a brief corrective statement regarding invalidity to improve test-taking behavior. Methods: This study is a multisite single-blind randomized controlled trial in a consecutive sample of clinically referred adult patients (N = 196) in a general hospital setting. Patients who failed a PVT (n = 71) were randomly allocated to a corrective statement approach (CS; n = 39), in which a brief verbal corrective statement was given by the technician, or received no corrective statement upon indications of invalid performance (NO-CS; n = 32). Both groups (CS and NO-CS) were provided with the same subsequently repeated and newly administered tests. Results: There were no group (CS vs. NO-CS) differences on both the repeated and single-administered PVTs and standard cognitive tests. Furthermore, invalid performing participants benefited significantly less from the repeated test administration compared to the valid performing group. Conclusions: Our study found that a brief corrective within-session statement, to address PVT failure and improve test-taking behavior, did not improve consequent test performance. These results suggest limited value of a brief verbal corrective statement to influence performance below best of capabilities. It highlights the need for more research to identify more effective approaches that can enhance patients test-taking behavior. Ultimately, such efforts are critical in ensuring accurate diagnosis and effective treatment recommendations for patients.
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Affiliation(s)
- Jeroen J Roor
- Department of Medical Psychology, VieCuri Medical Center, Venlo, the Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Brechje Dandachi-FitzGerald
- Faculty of Psychology, Open University Heerlen, Heerlen, the Netherlands
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Maarten J V Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Rudolf W H M Ponds
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Medical Psychology, Amsterdam University Medical Centres, location VU, Amsterdam, the Netherlands
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Boskovic I, Akca AYE. Presenting the consequences of feigning: Does it diminish symptom overendorsement? An analog study. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:575-584. [PMID: 35287519 DOI: 10.1080/23279095.2022.2044329] [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: 06/14/2023]
Abstract
Feigning causes personal and societal consequences, in both civil and criminal context. We investigated whether presenting the consequences of feigning can diminish symptom endorsement in feigned Posttraumatic Stress Disorder (PTSD). We randomly allocated non-native English speaking undergraduates (N = 145) to five conditions: 1) Truth tellers (n = 31), 2) Civil context feigners (n = 27), 3) Civil context warned feigners (n = 26), 4) Criminal context feigners (n = 29), and 5) Criminal context warned feigners (n = 32). All feigning groups received a vignette depicting a situation in which claiming PTSD would be beneficial. One vignette referred to the personal injury claim, whereas the second was about the aggravated assault charges. Additionally, one feigning group from each setting received information about the consequences of feigning (i.e., warned feigners). After receiving the instructions, all participants were administered the Self-Report Symptom Inventory (SRSI), a measure of symptom endorsement. Truth tellers endorsed fewer symptoms than all feigning groups, which mostly did not differ. Yet, criminal warned feigners (59%) were significantly less frequently detected on the SRSI as overreporters than other feigning groups (86.2%-89%). Hence, emphasizing the negative consequences of overreporting may diminish symptom endorsement, but only in high-stake situations. The implications and limitations (e.g., online measure administration) of this work are discussed.
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Affiliation(s)
- Irena Boskovic
- Erasmus University Rotterdam, Rotterdam, the Netherlands
- Maastricht University, Maastricht, the Netherlands
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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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Martin PK, Schroeder RW. Feedback with patients who produce invalid testing: Professional values and reported practices. Clin Neuropsychol 2020; 35:1134-1153. [PMID: 32031048 DOI: 10.1080/13854046.2020.1722243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Providing feedback to clinical patients who produce invalid neuropsychological test data presents with several potential challenges. Given the limited guidance available on the topic, neuropsychologists most likely utilize approaches that idiosyncratically incorporate professional values related to both assessment and patient care to address overarching feedback goals. The current article discusses professional values believed to inform feedback decisions and presents survey results regarding how neuropsychologists would approach feedback across various clinical scenarios where testing is invalid. METHOD Participants were 209 adult-focused clinical neuropsychologists recruited via professional listservs, the majority of whom reported being board certified. Respondents were provided three case vignettes of clinical patients who produced invalid test data and were asked how they would provide feedback to each patient. Open-ended responses were coded to determine the relative frequency of feedback approaches, explicit statements, and implied goals. RESULTS Nearly all respondents (98%) indicated that feedback would include some description of the invalid findings, and most respondents indicated that they would provide explanations for the reasons of invalidity (67%) and statements regarding the impact of invalidity on test interpretation (75%). There was little agreement across respondents, however, regarding specific feedback approach. Feedback goals included to Inform, Investigate, Treat, Educate, and Correct, with the presence of these implied goals also varying across respondents. CONCLUSIONS The findings indicate that there is minimal consensus regarding feedback approaches provided to patients who produce invalid test data and underscore a need for further development and validation of specific feedback methods. The results are discussed within the context of the potentially competing professional values of evidence-based assessment, patient-doctor collaboration, and aspirational principles of beneficence and fidelity.
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Affiliation(s)
- Phillip K Martin
- Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
| | - Ryan W Schroeder
- Psychiatry and Behavioral Sciences, University of Kansas School of Medicine, Wichita, KS, USA
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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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Roor JJ, Knoop H, Dandachi-FitzGerald B, Peters MJ, Bleijenberg G, Ponds RW. Feedback on underperformance in patients with Chronic Fatigue Syndrome: The impact on subsequent neuropsychological test performance. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:188-196. [DOI: 10.1080/23279095.2018.1519509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Jeroen J. Roor
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, Netherlands
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Brechje Dandachi-FitzGerald
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Maarten J.V. Peters
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Gijs Bleijenberg
- Expert Center for Chronic Fatigue, Department of Medical Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands
| | - Rudolf W.H.M. Ponds
- School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, Netherlands
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Niesten IJM, Müller W, Merckelbach H, Dandachi-FitzGerald B, Jelicic M. Moral Reminders Do Not Reduce Symptom Over-Reporting Tendencies. PSYCHOLOGICAL INJURY & LAW 2017; 10:368-384. [PMID: 29299087 PMCID: PMC5740206 DOI: 10.1007/s12207-017-9303-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/20/2017] [Indexed: 11/29/2022]
Abstract
Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. In study 1, we presented individuals seeking treatment for ADHD complaints (n = 24) with moral primes using the Mother Teresa Questionnaire and compared their scores on an index of symptom over-reporting (i.e., the Structured Inventory of Malingered Symptomatology, SIMS) with those of unprimed patient controls (n = 27). Moral primes slightly decreased SIMS scores, but the effect was not significant. In study 2, we took a different approach to activate moral categories: we recruited individuals seeking treatment for ADHD complaints and asked some of them to sign a moral contract (i.e., prime; n = 19) declaring that they would complete the tests in an honest way and compared their scores on the SIMS and standard clinical scales measuring self-reported psychopathology with those of unprimed patient controls (n = 17). Again, we found no convincing evidence that moral cues suppress symptom over-reporting. In study 3, we gave individuals from the general population (N = 132) positive, negative, or neutral moral primes and implicitly induced them to feign symptoms, after which they completed a brief validated version of the SIMS and an adapted version of the b Test (i.e., an underperformance measure). Again, primes did not affect over-reporting tendencies. Taken together, our findings illustrate that moral reminders are not going to be useful in clinical practice. Rather, they point towards the importance of studying contextual and individual difference factors that guide moral decision-making in patients and may be modified to discourage symptom over-reporting.
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Affiliation(s)
- Isabella J. M. Niesten
- Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Wenke Müller
- Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Harald Merckelbach
- Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Brechje Dandachi-FitzGerald
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marko Jelicic
- Clinical Psychological Science, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
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Affiliation(s)
- Henry Otgaar
- Section Forensic Psychology, Maastricht University, Maastricht, Netherlands
- Department of Psychology, City, University of London, London, UK
| | - Alysha Baker
- Department of Psychology, University of British Columbia, Kelowna, Canada
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Martin PK, Schroeder RW, Odland AP. Neuropsychologists’ Validity Testing Beliefs and Practices: A Survey of North American Professionals. Clin Neuropsychol 2015; 29:741-76. [DOI: 10.1080/13854046.2015.1087597] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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