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Rohling ML, Binder LM, Larrabee GJ, Langhinrichsen-Rohling J. Forced choice test score of p ≤ .20 and failures on ≥ six performance validity tests results in similar Overall Test Battery Means. Clin Neuropsychol 2024; 38:1193-1209. [PMID: 38041021 DOI: 10.1080/13854046.2023.2284975] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023]
Abstract
Objective: To determine if similar levels of performance on the Overall Test Battery Mean (OTBM) occur at different forced choice test (FCT) p-value score failures. Second, to determine the OTBM levels that are associated with failures at above chance on various performance validity (PVT) tests. Method: OTBMs were computed from archival data obtained from four practices. We calculated each examinee's Estimated Premorbid Global Ability (EPGA) and OTBM. The sample size was 5,103 examinees with 282 (5.5%) of these scoring below chance at p ≤ .20 on at least one FCT. Results: The OTBM associated with a failure at p ≤ .20 was equivalent to the OTBM that was associated with failing 6 or more PVTs at above-chance cutoffs. The mean OTBMs relative to increasingly strict FCT p cutoffs were similar (T scores in the 30s). As expected, there was an inverse relationship between the number of PVTs failed and examinees' OTBMs. Conclusions: The data support the use of p ≤ .20 as the probability level for testing the significance of below chance performance on FCTs. The OTBM can be used to index the influence of invalid performance on outcomes, especially when an examinee scores below chance.
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Ashendorf L, Withrow S, Ward SH, Sullivan SK, Sugarman MA. Decision rules for an abbreviated administration of the Test of Memory Malingering. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:382-391. [PMID: 35068279 DOI: 10.1080/23279095.2022.2026948] [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
The present study investigated abbreviation methods for the Test of Memory Malingering (TOMM) in relation to traditional manual-based test cutoffs and independently derived more stringent cutoffs suggested by recent research (≤48 on Trial 2 or 3). Consecutively referred outpatient U.S. military veterans (n = 260) were seen for neuropsychological evaluation for mild traumatic brain injury or possible attention-deficit/hyperactivity disorder. Performance on TOMM Trial 1 was evaluated, including the total score and errors on the first 10 items (TOMMe10), to determine correspondence and redundancy with Trials 2 and 3. Using the traditional cutoff, valid performance on Trials 2 and 3 was predicted by zero errors on TOMMe10 and by Trial 1 scores greater than 41. Invalid performance was predicted by commission of more than three errors on TOMMe10 and by Trial 1 scores less than 34. For revised TOMM cutoffs, a Trial 1 score above 46 was predictive of a valid score, and a TOMMe10 score of three or more errors or a Trial 1 score below 36 was associated with invalid TOMM performance. Conditional abbreviation of the TOMM is feasible in a vast majority of cases without sacrificing information regarding performance validity. Decision trees are provided to facilitate administration of the three trials.
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Affiliation(s)
- Lee Ashendorf
- Mental Health Service Line, VA Central Western Massachusetts, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Susanne Withrow
- Behavioral Health Service Line, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Sarah H Ward
- Mental Health Service Line, VA Central Western Massachusetts, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Sara K Sullivan
- Psychology Service, VA Bedford Healthcare System, Bedford, MA, USA
| | - Michael A Sugarman
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
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Liu C, Lu Q, Rao G, Chen X, Liang M, Liu Z. Malingering assessment after severe traumatic brain injury in forensic psychology with a potential embedded symptom validity indicator of Symptom Checklist 90. Front Psychol 2024; 15:1320636. [PMID: 38390415 PMCID: PMC10882088 DOI: 10.3389/fpsyg.2024.1320636] [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: 10/18/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Objective Malingering of neuropsychological damage is common among traumatic brain injury patients pursuing disability compensation in forensic contexts. There is an urgent need to explore differences in neuropsychological assessment outcomes with different levels of cooperation. Methods A total of 420 participants with severe traumatic brain injury were classified into malingering group, partial cooperation group, and complete cooperation group according to the Binomial forced-choice digit memory test. The Wechsler Adult Intelligence Scale, event-related potential component, and Symptom Checklist 90 were applied subsequently to assess the psychological status of participants. Results Participants in the malingering group presented lower scores in the binomial forced-choice digit memory test and the Wechsler Adult Intelligence Scale, lower P3 amplitude, and simultaneously higher scores in the Symptom Checklist 90 than the other two groups. The actual intelligence quotient of participants with malingering tendencies ranged mostly between normal and marginal damage, and they often reported elevated whole scale scores in the Symptom Checklist 90. The Cooperation Index (defined as the ratio of positive symptom distress index to global severity index, CI) was proposed and validated to function as an embedded validity indicator of the Symptom Checklist 90, and the area under the receiver operating characteristic (ROC) curve was 0.938. When valued at 1.28, CI has the highest classification ability in differentiating malingering from non-malingering. Combined with the CI and P3 amplitude, the area under the ROC curve for malingering diagnosis further reached 0.952. Conclusion Any non-optimal effort in a forensic context will lead to unexpected deviation in psychology evaluation results. CI is a potential candidate to act as an embedded validity indicator of the Symptom Checklist 90. The combination of CI and P3 amplitude can help to identify malingering in participants after severe traumatic brain injury.
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Affiliation(s)
- Cong Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiuying Lu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Forensic Medicine, Shaoxing University Forensic Center, Shaoxing, China
| | - Guangxun Rao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaorui Chen
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Man Liang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zilong Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Ton Loy AF, Lee JE, Asimakopoulos G, Sakamoto MS, Merritt VC. Symptom attribution is a stronger predictor of PVT-failure than symptom endorsement in treatment-seeking Veterans with remote mTBI history: A pilot study. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-6. [PMID: 38113857 DOI: 10.1080/23279095.2023.2293979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To examine relationships between performance validity testing (PVT), neurobehavioral symptom endorsement, and symptom attribution in Veterans with a history of mild traumatic brain injury (mTBI). METHOD Participants included treatment-seeking Veterans (n = 37) with remote mTBI histories who underwent a neuropsychological assessment and completed a modified version of the Neurobehavioral Symptom Inventory (NSI) to assess symptom endorsement and symptom attribution (the latter evaluated by having Veterans indicate whether they believed each NSI symptom was caused by their mTBI). Veterans were divided into two subgroups, PVT-Valid (n = 25) and PVT-Invalid (n = 12). RESULTS Independent samples t-tests showed that two of five symptom endorsement variables and all five symptom attribution variables were significantly different between PVT groups (PVT-Invalid > PVT-Valid; Cohen's d = 0.67-1.02). Logistic regression analyses adjusting for PTSD symptoms showed that symptom endorsement (Nagelkerke's R2 = .233) and symptom attribution (Nagelkerke's R2 = .279) significantly distinguished between PVT groups. According to the Wald criterion, greater symptom endorsement (OR = 1.09) and higher attribution of symptoms to mTBI (OR = 1.21) each reliably predicted PVT-failure. CONCLUSIONS While both symptom endorsement and symptom attribution were significantly associated with PVT-failure, our preliminary results suggest that symptom attribution is a stronger predictor of PVT-failure. Results highlight the importance of assessing symptom attribution to mTBI in this population.
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Affiliation(s)
- Adan F Ton Loy
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | - Jeong-Eun Lee
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
| | | | - McKenna S Sakamoto
- Department of Psychology, Penn State University, University Park, PA, USA
| | - Victoria C Merritt
- Research Service, VA San Diego Healthcare System (VASDHS), San Diego, CA, USA
- Department of Psychiatry, School of Medicine, UC San Diego, La Jolla, CA, USA
- Center of Excellence for Stress and Mental Health, VASDHS, San Diego, CA, USA
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O’Neil ME, Agyemang A, Walker WC, Pogoda TK, Klyce DW, Perrin PB, Hsu NH, Nguyen H, Presson AP, Cifu DX. Demographic, military, and health comorbidity variables by mild TBI and PTSD status in the LIMBIC-CENC cohort. Brain Inj 2022; 36:598-606. [DOI: 10.1080/02699052.2022.2033847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Maya E. O’Neil
- VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Amma Agyemang
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - William C. Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Central Virginia VA Healthcare System, Richmond, Virginia, USA
| | - Terri K. Pogoda
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel W. Klyce
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Central Virginia VA Healthcare System, Richmond, Virginia, USA
- Sheltering Arms Institute, Richmond, Virginia, USA
| | - Paul B. Perrin
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Central Virginia VA Healthcare System, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nancy H. Hsu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Huong Nguyen
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Angela P. Presson
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David X. Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
- Innovation and System Integration, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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OUP accepted manuscript. Arch Clin Neuropsychol 2022; 37:1158-1176. [DOI: 10.1093/arclin/acac020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 11/14/2022] Open
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Apolipoprotein e (APOE) ε4 genotype influences memory performance following remote traumatic brain injury in U.S. military service members and veterans. Brain Cogn 2021; 154:105790. [PMID: 34487993 DOI: 10.1016/j.bandc.2021.105790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to examine the association between the apolipoprotein E (APOE) ε4 allele and neurocognitive functioning following traumatic brain injury (TBI) in military service members and veterans (SMVs). Participants included 176 SMVs with a history of remote TBI (≥1 year post-injury), categorized into mild (n = 100), moderate (n = 40), and severe (n = 36) TBI groups. Participants completed a neuropsychological assessment and APOE genotyping (n = 46 ε4+, n = 130 ε4-). Neurocognitive composite scores representing memory, executive functioning, and visual processing speed were computed. ANCOVAs adjusting for race, education, combat exposure, and PTSD symptom severity showed a significant main effect of ε4 on the memory composite, such that ε4+ SMVs exhibited poorer memory performance than ε4- SMVs. When ε2 allele carriers were removed from the analyses, associations with memory were strengthened, demonstrating a possible protective effect of the ε2 allele. No main effect of TBI group was identified on any cognitive composite, nor were there any significant TBI group × ε4 status interactions for any cognitive composite. Future studies with larger samples are needed to verify these findings, but our results suggest an important relationship between ε4 status and memory functioning following remote TBI of all severities.
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Donders J, Lefebre N, Goldsworthy R. Patterns of Performance and Symptom Validity Test Findings After Mild Traumatic Brain Injury. Arch Clin Neuropsychol 2021; 36:394-402. [PMID: 31732733 DOI: 10.1093/arclin/acz057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/03/2019] [Accepted: 08/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the presence of demographic, injury and neuropsychological correlates of distinct patterns of performance validity test and symptom validity test results in persons with mild traumatic brain injury (mTBI). METHOD One hundred and seventy-eight persons with mTBI completed the Test of Memory Malingering (TOMM; performance validity) and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF; symptom validity) within 1-12 months postinjury. Four groups were compared: (a) pass both TOMM and MMPI-2-RF validity criteria, (b) pass TOMM and fail MMPI-2-RF, (c) fail TOMM and pass MMPI-2-RF, and (d) fail both TOMM and MMPI-2-RF. RESULTS Compared to Group a, participants in combined Groups b-d were more than twice as likely to be engaged in financial compensation-seeking and about four times less likely to have neuroimaging evidence of an intracranial lesion. The average performance of Group d on an independent test of verbal learning was more than 1.5 standard deviations below that of Group a. Participants in Group b were more likely to have intracranial lesions on neuroimaging than participants in Group c. CONCLUSION Performance and symptom validity tests provide complementary and non-redundant information in persons with mTBI. Whereas financial compensation-seeking is associated with increased risk of failure of either PVT or SVT, or both, the presence of intracranial findings on neuroimaging is associated with decreased risk of such.
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Affiliation(s)
- Jacobus Donders
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
| | - Nathan Lefebre
- Department of Psychology, Calvin College, Grand Rapids, MI, USA
| | - Rachael Goldsworthy
- Department of Psychology, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI, USA
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A Meta-Analysis of Neuropsychological Effort Test Performance in Psychotic Disorders. Neuropsychol Rev 2020; 30:407-424. [PMID: 32766940 DOI: 10.1007/s11065-020-09448-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
Abstract
Psychotic disorders are characterized by a generalized neurocognitive deficit (i.e., performance 1.5 SD below controls across neuropsychological domains with no specific profile of differential deficits). A motivational account of the generalized neurocognitive deficit has been proposed, which attributes poor neuropsychological testing performance to low effort. However, findings are inconsistent regarding effort test failure rate in individuals with psychotic disorders across studies (0-72%), and moderators are unclear, making it difficult to know whether the motivational explanation is viable. To address these issues, a meta-analysis was performed on data from 2205 individuals with psychotic disorders across 19 studies with 24 independent effects. Effort failure rate was examined along with moderators of effort test type, forensic status, IQ, positive symptoms, negative symptoms, diagnosis, age, gender, education, and antipsychotic use. The pooled weighted effort test failure rate was 18% across studies and there was a moderate pooled association between effort failure rate and global neurocognitive performance (r = .57). IQ and education significantly moderated failure rate. Collectively, these findings suggest that a nontrivial proportion of individuals with a psychotic disorder fail effort testing, and failure rate is associated with global neuropsychological impairment. However, given that effort tests are not immune to the effects of IQ in psychotic disorders, these results cannot attest to the viability of the motivational account of the generalized neurocognitive deficit. Furthermore, the significant moderating effect of IQ and education on effort test performance suggests that effort tests have questionable validity in this population and should be interpreted with caution.
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Psychometric Evaluation of Anxiety, Depression, and Sleep Quality after a Mild Traumatic Brain Injury: A Longitudinal Study. Behav Neurol 2019; 2019:4364592. [PMID: 31110595 PMCID: PMC6487154 DOI: 10.1155/2019/4364592] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/22/2019] [Indexed: 02/08/2023] Open
Abstract
Introduction. Over 1 million mild traumatic brain injury (mTBI) cases are reported annually worldwide and may result in cognitive, physical, and emotional deterioration; depression; anxiety; and sleep problems. However, studies on long-term mTBI effects are limited. This study included 440 patients, and regular follow-ups of psychological assessments were performed for 2 years. Four questionnaires, including the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), Beck's anxiety inventory (BAI), and Beck's depression inventory (BDI), were used to evaluate sleep problems, daytime sleepiness, anxiety, and depression, respectively. Results show that BAI and BDI scores considerably improved at the 6th-week, 1st-year, and 2nd-year follow-ups compared to baseline, yet these remained significantly different. In addition, anxiety and depression were prominent symptoms in a select subgroup of patients with poor initial evaluations, which improved over the 2 years. However, the ESS and PSQI scores fluctuated only mildly over the same time span. In conclusion, the mTBI patients showed a gradual improvement of anxiety and depression over the 2 years following injury. While anxiety and depression levels for mTBI patients in general did not return to premorbid status, improvements were observed. Sleep disorders persisted and were consistent with initial levels of distress.
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Kenzie ES, Parks EL, Bigler ED, Wright DW, Lim MM, Chesnutt JC, Hawryluk GWJ, Gordon W, Wakeland W. The Dynamics of Concussion: Mapping Pathophysiology, Persistence, and Recovery With Causal-Loop Diagramming. Front Neurol 2018; 9:203. [PMID: 29670568 PMCID: PMC5893805 DOI: 10.3389/fneur.2018.00203] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/14/2018] [Indexed: 12/21/2022] Open
Abstract
Despite increasing public awareness and a growing body of literature on the subject of concussion, or mild traumatic brain injury, an urgent need still exists for reliable diagnostic measures, clinical care guidelines, and effective treatments for the condition. Complexity and heterogeneity complicate research efforts and indicate the need for innovative approaches to synthesize current knowledge in order to improve clinical outcomes. Methods from the interdisciplinary field of systems science, including models of complex systems, have been increasingly applied to biomedical applications and show promise for generating insight for traumatic brain injury. The current study uses causal-loop diagramming to visualize relationships between factors influencing the pathophysiology and recovery trajectories of concussive injury, including persistence of symptoms and deficits. The primary output is a series of preliminary systems maps detailing feedback loops, intrinsic dynamics, exogenous drivers, and hubs across several scales, from micro-level cellular processes to social influences. Key system features, such as the role of specific restorative feedback processes and cross-scale connections, are examined and discussed in the context of recovery trajectories. This systems approach integrates research findings across disciplines and allows components to be considered in relation to larger system influences, which enables the identification of research gaps, supports classification efforts, and provides a framework for interdisciplinary collaboration and communication-all strides that would benefit diagnosis, prognosis, and treatment in the clinic.
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Affiliation(s)
- Erin S. Kenzie
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Elle L. Parks
- Systems Science Program, Portland State University, Portland, OR, United States
| | - Erin D. Bigler
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
| | - David W. Wright
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Miranda M. Lim
- Sleep Disorders Clinic, Division of Hospital and Specialty Medicine, Research Service, VA Portland Health Care System, Portland, OR, United States
- Departments of Neurology, Medicine, and Behavioral Neuroscience, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, United States
| | - James C. Chesnutt
- TBI/Concussion Program, Orthopedics & Rehabilitation, Neurology and Family Medicine, Oregon Health & Science University, Portland, OR, United States
| | | | - Wayne Gordon
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Wayne Wakeland
- Systems Science Program, Portland State University, Portland, OR, United States
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Lippa SM. Performance validity testing in neuropsychology: a clinical guide, critical review, and update on a rapidly evolving literature. Clin Neuropsychol 2017; 32:391-421. [DOI: 10.1080/13854046.2017.1406146] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Sara M. Lippa
- Defense and Veterans Brain Injury Center, Silver Spring, MD, USA
- Walter Reed National Military Medical Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Bethesda, MD, USA
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