Preliminary findings from reevaluating the MMPI Response Bias Scale items in veterans undergoing neuropsychological evaluation

The Response Bias Scale (RBS) was developed to predict non-credible cognitive presentations among disability claimants without head injury. Developers used empirical keying, which is independent of apparent content, to select items from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) item pool that distinguished between individuals passing or failing performance validity tests (PVTs). No study has examined which of these items would have psychometric value when used in clinical neuropsychological evaluations. This study reexamined items comprising RBS with reference to manifest item content, internal consistency, PVTs, and a symptom validity test (SVT) in a sample of 173 predominately White male veterans (MAGE = 50.70, MEDU = 13.73) in a VA outpatient neuropsychology clinic. Participants completed the MMPI-2 Restructured Form (MMPI-2-RF), PVTs, and an SVT. The 28-item RBS appears to contain three types of items: those that manifestly address cognitive functioning, those that are supported but do not appear to address cognitive functioning, and nine items that were unrelated to cognition and not statistically supported. The 19 empirically supported items, or RBS-19, predicted PVT and SVT failures marginally better than the RBS. Both the RBS and RBS-19 had stronger relationships with SVTs relative to PVTs. Although the removal of the nine problematic items improved the diagnostic accuracy of the scale, it still did not reach the level that is generally considered to be clinically optimal. The RBS-19 offers a measure with improved internal consistency and predictive validity compared to the RBS and warrants additional research.

Cross validation of the response bias scale and the response bias scale-19 in active-duty personnel: use on the MMPI-2-RF and MMPI-3

The Response Bias Scale (RBS) is the central measure of cognitive over-reporting in the MMPI-family of instruments. Relative to other clinical populations, the research evaluating the detection of over-reporting is more limited in Veteran and Active-Duty personnel, which has produced some psychometric variability across studies. Some have suggested that the original scale construction methods resulted in items which negatively impact classification accuracy and in response crafted an abbreviated version of the RBS (RBS-19; Ratcliffe et al., 2022; Spencer et al., 2022). In addition, the most recent edition of the MMPI is based on new normative data, which impacts the ability to use existing literature to determine effective cut-scores for the RBS (despite all items having been retained across MMPI versions). To date, no published research exists for the MMPI-3 RBS. The current study examined the utility of the RBS and the RBS-19 in a sample of Active-Duty personnel (n = 186) referred for neuropsychological evaluation. Using performance validity tests as the study criterion, we found that the RBS-19 was generally equitably to RBS in classification. Correlations with other MMPI-2-RF over- and under-reporting symptom validity tests were slightly stronger for RBS-19. Implications and directions for research and practice with RBS/RBS-19 are discussed, along with implications for neuropsychological assessment and response validity theory.

Embedded cognitive and emotional/affective self-reported symptom validity indices on the patient competency rating scale

OBJECTIVE

Although there is an abundance of research on stand-alone and embedded performance validity tests and stand-alone symptom validity tests (SVTs), less emphasis has been placed on embedded SVTs. The goal of the current study was to examine the ability of embedded indicators within the Patient Competency Rating Scale (PCRS) to separately detect invalid cognitive and/or emotional/affective symptom responding.

METHOD

Participants included 299 veterans assessed in a VA medical center epilepsy monitoring unit from 2013-2017 (mean age = 48.8 years, SD = 13.5 years). Two SVT composites were created; self-reported cognitive symptom validity (SVT-C) and self-reported emotional/affective symptom validity (SVT-E). Groups were compared on PCRS total and index scores (i.e., cognitive, activities of daily living, emotional, and interpersonal competencies) using ANOVAs. Receiver operating characteristic (ROC) curve analyses assessed the classification accuracy of the PCRS total and index scores for SVT-C and SVT-E.

RESULTS

In ANOVAs, SVT-C was significantly associated with all PCRS indices, while SVT-E was only significantly associated with the PCRS total, emotional, and interpersonal competency indices. Although the PCRS-T ≤ 90 had the strongest classification of SVT-C and SVT-E (specificities: .90, sensitivities: .44 to .50), PCRS index scores showed suggestive evidence of domain specificity, with PCRS-ADL ≤22, PCRS-C ≤ 20, and PCRS-CADL ≤45 best classifying SVT-C (specificities: .92, sensitivities: .33) and the PCRS-E ≤ 18 best classifying the SVT-E group (specificity: .93, sensitivity: .40).

CONCLUSION

Results suggest the PCRS may be used to obtain clinically useful information while including embedded indicators that can assess cognitive and/or emotional/affective symptom invalidity.

An Australian study on feigned mTBI using the Inventory of Problems - 29 (IOP-29), its Memory Module (IOP-M), and the Rey Fifteen Item Test (FIT)

We investigated the classification accuracy of the Inventory of Problems - 29 (IOP-29), its newly developed memory module (IOP-M) and the Fifteen Item Test (FIT) in an Australian community sample (N = 275). One third of the participants (n = 93) were asked to respond honestly, two thirds were instructed to feign mild TBI. Half of the feigners (n = 90) were coached to avoid detection by not exaggerating, half were not (n = 92). All measures successfully discriminated between honest responders and feigners, with large effect sizes (d ≥ 1.96). The effect size for the IOP-29 (d ≥ 4.90), however, was about two-to-three times larger than those produced by the IOP-M and FIT. Also noteworthy, the IOP-29 and IOP-M showed excellent sensitivity (>90% the former, > 80% the latter), in both the coached and uncoached feigning conditions, at perfect specificity. Instead, the sensitivity of the FIT was 71.7% within the uncoached simulator group and 53.3% within the coached simulator group, at a nearly perfect specificity of 98.9%. These findings suggest that the validity of the IOP-29 and IOP-M should generalize to Australian examinees and that the IOP-29 and IOP-M likely outperform the FIT in the detection of feigned mTBI.

Deception is different: Negative validity test findings do not provide "evidence" for "good effort"

OBJECTIVE

The purpose of this paper is to determine whether negative validity test findings should be used in the Bayesian aggregate along with positive test findings for the determination of malingering as the condition of interest (COI). Method: Evidence-based diagnostic methods for conditions in neuropsychology and medicine were reviewed for comparison with their use in cases of malingering. Logical and Bayesian analyses of these cases were applied. A case study showed that negative validity test findings did not indicate "good effort". Results: Deception about illness is fundamentally different from other constructs/diseases in evidence-based medicine and neuropsychology. This is because deception involves a deliberate process that may involve coaching, claimant research, and/or focusing the deception on one aspect (e.g., slowness) as opposed to other neurocognitive problems (e.g., memory). Comparatively, other conditions in medicine and neuropsychology are unlikely to be manipulated by the patient. Conclusions: The assertion by Frederick (2015) and Black, Necrason, and Omasta (2016) that both positive and negative validity test findings must be used together in the aggregate does not stand up to this comparative scrutiny. The fundamental assumption by these authors that a negative test finding concerning malingering represents "good effort" is flawed; it simply represents lack of evidence of malingering, which cannot be construed as evidence of lack of malingering. We recommend that in forensic determination of malingering, negative validity test findings should not be used in a Bayesian aggregation. This conclusion is consistent with current practices in the field.

The Impact of Self-Efficacy and Health Locus of Control on Performance Validity Testing

OBJECTIVE

Recent research has examined potential influences to performance validity testing beyond intentional feigning. The current study sought to examine the hypothesized relationships of two psychological constructs (self-efficacy and health locus of control) with performance validity testing (PVT).

METHOD

Retrospective review of 158 mild traumatic brain injury (mTBI) cases referred to an Army outpatient clinic for neuropsychological evaluation. The mTBI cases were classified according to passing or failing the Medical Symptom Validity Test (MSVT) or Non-Verbal Medical Symptom Validity Test (NV-MSVT). Group comparisons were performed utilizing one-way ANOVA to evaluate the differences between the PVT-Pass and PVT-Fail groups on self-efficacy (MMPI-2-RF Inefficacy scale) and locus of control (Multi-Dimensional Health Locus of Control).

RESULTS

There was no relationship between self-efficacy or health locus of control and passing/failing PVTs.

CONCLUSIONS

Further research is warranted to explore potential influences on PVT performance, which we conceptualize as analogous to experimental nuisance variables that may be amenable to intervention.

Multidimensional Malingering Criteria for Neuropsychological Assessment: A 20-Year Update of the Malingered Neuropsychological Dysfunction Criteria

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.

Evaluating the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) over-reporting scales in a military neuropsychology clinic

Introduction: This study examines the utility of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) validity scales to detect invalid responding within a sample of active duty United States Army soldiers referred for neuropsychological evaluations.Method: This study examines the relationship between performance validity testing and performance on the MMPI-2-RF over-reporting scales. Specifically, mean differences between those who passed (n = 152; 75.6%) or failed (n = 49; 24.4%) performance validity testing were compared. Receiver operator characteristic analyzes were also conducted to expand available information on the MMPI-2-RF over-reporting sensitivity and specificity in an Army sample.Results: This study has two distinct findings. First, effect size differences between those passing and failing performance validity testing are classified as small to medium in magnitude (ranging from d = . 30/g = .32 on F-r to d = .66/g = .73 on RBS). Second, over-reporting scales have higher specificity and poorer sensitivity. Likewise, performance of the over-reporting scales suggests that those who exceeding recommended cut scores are likely to have failed extra-test performance validity measures.Conclusion: These findings suggest that many who fail external performance measures may be undetected on the MMPI-2-RF over-reporting scales and that those exceeding recommended cut scores are likely to have failed extra-test performance validity testing. Implications for research on, and practice with, the MMPI-2-RF in military populations are discussed.