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Di Vico IA, Stone J, Mcwhirter L, Riello M, Zanolin ME, Colombari M, Fiorio M, Tinazzi M. Performance validity tests in nonlitigant patients with functional motor disorder. Eur J Neurol 2023; 30:806-812. [PMID: 36692870 DOI: 10.1111/ene.15703] [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: 10/24/2022] [Revised: 12/09/2022] [Accepted: 12/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Performance validity tests (PVTs) are used in neuropsychological assessments to detect patterns of performance suggesting that the broader evaluation may be an invalid reflection of an individual's abilities. Data on functional motor disorder (FMD) are currently poor and conflicting. We aimed to examine the rate of failure on three different PVTs of nonlitigant, non-compensation-seeking FMD patients, and we compared their performance to that of healthy controls and controls asked to simulate malingering (healthy simulators). METHODS We enrolled 29 nonlitigant, non-compensation-seeking patients with a clinical diagnosis of FMD, 29 healthy controls, and 29 healthy simulators. Three PVTs, the Coin in the Hand Test (CIH), the Rey 15-Item Test (REY), and the Finger Tapping Test (FTT), were employed. RESULTS Functional motor disorder patients showed low rates of failure on the CIH and REY (7% and 10%, respectively) and slightly higher rates on the FTT (15%, n = 26), which implies a motor task. Their performance was statistically comparable to that of healthy controls but statistically different from that of healthy simulators (p < 0.001). Ninety-three percent of FMD patients, 7% of healthy simulators, and 100% of healthy controls passed at least two of the three tests. CONCLUSIONS Performance validity test performance of nonlitigant, non-compensation-seeking patients with FMD ranged from 7% to 15%. Patients' performance was comparable to that of controls and significantly differed from that of simulators. This simple battery of three PVTs could be of practical utility and routinely used in clinical practice.
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Affiliation(s)
- Ilaria A Di Vico
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Marlene and Paolo Fresco Institute for Parkinson's and Movement Disorders, NYU Langone Health, New York, New York, USA
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Laura Mcwhirter
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Marianna Riello
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Maria Elisabetta Zanolin
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Michela Colombari
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Mirta Fiorio
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
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Martin PK, Schroeder RW, Olsen DH. Performance validity in the dementia clinic: Specificity of validity tests when used individually and in aggregate across levels of cognitive impairment severity. Clin Neuropsychol 2020; 36:165-188. [DOI: 10.1080/13854046.2020.1778790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Phillip K. Martin
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine – Wichita, Wichita, KS, USA
| | - Ryan W. Schroeder
- Department of Psychiatry and Behavioral Sciences, University of Kansas School of Medicine – Wichita, Wichita, KS, USA
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Daugherty JC, Querido L, Quiroz N, Wang D, Hidalgo-Ruzzante N, Fernandes S, Pérez-García M, De Los Reyes-Aragon CJ, Pires R, Valera E. The Coin in Hand-Extended Version: Development and Validation of a Multicultural Performance Validity Test. Assessment 2019; 28:186-198. [PMID: 31347383 DOI: 10.1177/1073191119864652] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The number of computerized and reliable performance validity tests are scarce. This study aims to address this issue by validating a free and computerized performance validity test: the Coin in Hand-Extended Version (CIH-EV). The CIH-EV test was administered in four countries (Colombia, Spain, Portugal, and the United States) and performance was compared with other commonly used validated tests. Results showed that the CIH-EV has at least 95% specificity and 62% sensitivity, and performance was highly correlated with scores on the Test of Memory Malingering, Victoria Symptom Validity Test, and Digit Span of the Wechsler Adult Intelligence Scale. There were no significant differences in scores across countries, suggesting that the CIH-EV performs similarly in a variety of cultures. Our findings suggest that the CIH-EV has the potential to serve as a valid validity test either alone or as a supplement to other commonly used validity tests.
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Affiliation(s)
- Julia C Daugherty
- The Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, Universidad de Granada, Spain
| | - Luis Querido
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Nathalia Quiroz
- Psychology Department, Universidad del Norte, Baranquilla, Colombia
| | - Diana Wang
- Department of Psychiatry, Harvard Medical School, Boston, United States
| | - Natalia Hidalgo-Ruzzante
- The Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Evolutionary and School Psychology, Universidad de Granada, Spain
| | - Sandra Fernandes
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Miguel Pérez-García
- The Mind, Brain and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain.,Department of Personality, Evaluation, and Psychological Treatment, Universidad de Granada, Spain
| | | | - Rute Pires
- Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal.,CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisboa, Portugal
| | - Eve Valera
- Department of Psychiatry, Harvard Medical School, Boston, United States
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Barhon LI, Batchelor J, Meares S, Chekaluk E, Shores EA. A Comparison of the Degree of Effort Involved in the TOMM and the ACS Word Choice Test Using a Dual-Task Paradigm. APPLIED NEUROPSYCHOLOGY-ADULT 2014; 22:114-23. [DOI: 10.1080/23279095.2013.863775] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Reuber M, Howlett S, Kemp S. Psychologic treatment of patients with psychogenic nonepileptic seizures. Expert Rev Neurother 2014; 5:737-52. [PMID: 16274332 DOI: 10.1586/14737175.5.6.737] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Psychogenic nonepileptic seizures are relatively common, often disabling and costly to patients and society. Most authorities consider psychologic treatment as the therapeutic intervention of choice. This review is intended primarily for psychologists and therapists who treat patients with psychogenic nonepileptic seizures, and for neurologists who make the diagnosis and wish to find out more about psychologic treatment options. The first section describes the nature and etiology of psychogenic nonepileptic seizures. General questions regarding the psychologic treatment of patients with psychogenic nonepileptic seizures are addressed, before discussing specific therapeutic approaches. The final part summarizes the authors' views on optimal treatment and the direction of future research.
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Affiliation(s)
- Markus Reuber
- Academic Neurology Unit, University of Sheffield, Department of Neurology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK.
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Hampson NE, Kemp S, Coughlan† AK, Moulin CJA, Bhakta BB. Effort Test Performance in Clinical Acute Brain Injury, Community Brain Injury, and Epilepsy Populations. APPLIED NEUROPSYCHOLOGY-ADULT 2013; 21:183-94. [DOI: 10.1080/09084282.2013.787425] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Natalie E. Hampson
- a Department of Neuropsychology , Salford Royal NHS Foundation Trust , Salford , United Kingdom
| | - Steven Kemp
- b Department of Neuropsychology , St. James's University Hospital , Leeds , United Kingdom
| | - Anthony K. Coughlan†
- b Department of Neuropsychology , St. James's University Hospital , Leeds , United Kingdom
| | | | - Bipin B. Bhakta
- d Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health , University of Leeds , Leeds , United Kingdom
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Kelly PJ, Baker GA, van den Broek MD, Jackson H, Humphries G. The detection of malingering in memory performance: The sensitivity and specificity of four measures in a UK population. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 44:333-41. [PMID: 16252435 DOI: 10.1348/014466505x35687] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To investigate the validity of a clinical neuropsychological battery for the detection of malingering on tests of memory. METHODS A simulated scenario design was developed to investigate the effectiveness of a battery of four neuropsychological tests in the detection of malingering; the Coin in the Hand Test (CIH), Autobiographical Memory Index (AMI), Rey I 5-Item Test (RIT),and the Wechsler Mental Control Test (MCT). The performances of patients with an acquired brain injury (N = 40) were compared with two groups of controls instructed either to simulate a head injury performance (N = 40) or do their best (N = 40). RESULTS The CIH and MCT demonstrated good validity and displayed high sensitivity and specificity. The RIT and the AMI was relatively poor in distinguishing between simulators and patients. CONCLUSIONS The sensitivity and specificity of all four tests to the detection of malingering has been assessed. Two of the tests the CIH and MCT would be useful as a quick and accurate screening tool for detecting malingering.
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Affiliation(s)
- P J Kelly
- Neurological Sciences, Clinical Science Center for Research and Education, Liverpool, UK
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Rudman N, Oyebode JR, Jones CA, Bentham P. An investigation into the validity of effort tests in a working age dementia population. Aging Ment Health 2011; 15:47-57. [PMID: 20924821 DOI: 10.1080/13607863.2010.508770] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Performance on neuropsychological tests can be influenced by non-cognitive factors, including deliberate underperformance, stress, the need to fulfil a sick role, depression, un-cooperativeness, fatigue and unhappiness with the evaluative situation. Tests to detect suboptimal effort are becoming widely used in clinical practice and are based on their reported insensitivity to cognitive dysfunction. A diagnosis of dementia has life-changing implications for an individual of working age. It is therefore crucial that clinicians can be confident they have obtained a valid estimate of current cognitive functioning. This study aimed to establish whether mood or cognitive functioning adversely influenced performance on symptom validity tests (SVTs) in individuals with working age dementia, who were judged to be using full effort. METHOD Forty-two participants with dementia diagnosed before the age of 65 completed measures of emotional and cognitive functioning and six SVTs. RESULTS There were no significant correlations between emotional functioning and measures of effort. However, cognitive functioning, in particular new learning, was significantly related to SVT performance. Participants with mild dementia performed significantly better on all six SVTs than those with moderate/severe dementia. The results also suggest that the SVTs are not equally sensitive to cognitive dysfunction. Rey's Dot Counting Test (DCT) (times criterion) achieved 100% specificity, and was the only test passed by every participant. CONCLUSION Rey's DCT is the only SVT that can be recommended for use in those under 65 years with possible dementia at this time until further validation studies are undertaken.
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Affiliation(s)
- Natalie Rudman
- South Birmingham Primary Care Trust, Moseley Hall Hospital, Birmingham, UK
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Kemp S, Coughlan AK, Rowbottom C, Wilkinson K, Teggart V, Baker G. The base rate of effort test failure in patients with medically unexplained symptoms. J Psychosom Res 2008; 65:319-25. [PMID: 18805240 DOI: 10.1016/j.jpsychores.2008.02.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 02/05/2008] [Accepted: 02/05/2008] [Indexed: 11/25/2022]
Abstract
BACKGROUND "Effort tests" (i.e., tests that indicate whether appropriate effort is being made) are increasingly used in neuropsychological assessments. However, not all failures on effort tests are necessarily attributable to lack of effort. Understanding the factors that contribute to failure on effort tests has important clinical implications. OBJECTIVES This study aimed (a) to establish the extent to which patients with medically unexplained symptoms (MUS) presenting to neurology fail effort tests, (b) examine the performance of "mild" and "strong" simulators on effort tests, and (c) compare the performance of simulators and MUS patients. METHODS Forty-three MUS patients, 35 mild simulators, and 39 strong simulators undertook a battery of effort tests. The groups were matched for age, estimated IQ, and gender. The MUS patients were not involved in litigation. RESULTS The failure rate (defined as failing two or more effort tests) was 11% in the MUS group, 94% in the mild simulation groups, and 100% in the strong simulation group. CONCLUSIONS A minority of nonlitigant MUS patients who present to neurology fail effort tests. Possible reasons for this are discussed. In that they do not produce below-chance performance (in contrast with many of the simulators), there is no clear indication of deliberate failure, though this cannot be ruled out. The very high failure rate in the mild simulation group (who were instructed not to overact) indicates the sensitivity of effort tests to lack of effort and the value of including such tests in neuropsychological assessments.
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Affiliation(s)
- Steven Kemp
- St. James's University Hospital, Leeds, Leeds, UK.
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Merckelbach H, Devilly GJ, Rassin E. Alters in dissociative identity disorder. Metaphors or genuine entities? Clin Psychol Rev 2002; 22:481-97. [PMID: 12094508 DOI: 10.1016/s0272-7358(01)00115-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
How should the different identities (i.e., alters) that are thought to be typical for dissociative identity disorder (DID) be interpreted? Are they just metaphors for different emotional states or are they truly autonomous entities that are capable of willful action? This issue is important because it has implications for the way in which courts may handle cases that involve DID patients. Referring to studies demonstrating that alters of DID patients differ in their memory performance or physiological profile, some authors have concluded that alters are more than just metaphors. We argue that such line of reasoning is highly problematic. There is little consensus among authors about the degree to which various types of memory information (implicit, explicit, procedural) may leak from one to the other alter. Without such theoretical accord, any given outcome of memory studies on DID may be taken as support for the assumption that alters are in some sense "real." As physiological studies on alter activity often lack proper control conditions, most of them are inconclusive as to the status of alters. To date, neither memory studies nor psychobiological studies have delivered compelling evidence that alters of DID patients exist in a factual sense. As a matter of fact, results of these studies are open to multiple interpretations and in no way refute an interpretation of alters in terms of metaphors for different emotional states.
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Affiliation(s)
- Harald Merckelbach
- Department of Experimental Psychology, Faculty of Law, University of Maastricht, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
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