Malingering

What are performance validity tests (PVTs) used for?

Used to identify diminished capacity

What are symptom validity tests (SVTs) used for?

They are indicators of symptom exaggeration and can distinguish credible from noncredible symptoms in examinees

What is response bias?

Misrepresentation of performance capacities in any neuropsychological domain

What are embedded measures?

Validity tests that are built into neuropsychological ability tests that were not primarily developed for assessing validity

What is sensitivity?

The probability that a sign will be positive given that the disorder is present. Increasing test sensitivity reduces the likelihood of false negative error

What is specificity?

The probability that a sign will be negative given that the disorder is not present. Increasing test specificity reduces the likelihood of false positive errors

Why was the Slick criteria made?

SVTs at the time only had moderate sensitivity and low negative predictive power and limited research on malingering

What did Slick et al.'s criteria put forth?

A formal definition for malingering and a set of diagnostic criteria for malingered neurocognitive dysfunction (MND)

What were Slick's et al.'s diagnostic categories?

Definite MND, probable MND, possible MND

What were Slick's et al.'s criteria A?

presence of a substantial external incentive

What were Slick's et al.'s criteria B?

Evidence from neuropsychological testing

What were Slick's et al.'s criteria C?

Evidence from self-report

What were Slick's et al.'s criteria D?

Behaviors meeting necessary criteria from groups B or C are not fully accounted for by Psychiatric, Neurological, or Developmental Factors

What do all definitions of malingering have in common?

All say that exaggeration or feigning of dysfunction must be motivated by an external incentive and it is driving the feigning behavior

What are the different formats of PVTs?

Stand alone (TOMM), force-choice (WMT), embedded (RDS), non-force choice

What's the average number of validity tests in a battery?

2-4

What's the average number of validity tests in a forensic battery?

5-7

How have cut-offs changed over time?

They have been lowered to limit false positives and they are not consistent across the field

What is a big problem in validity testing?

Some patients are coached that if something seems too easy, they should make sure to do well on that

What are some current trends in validity testing?

Virtual reality assessment programs (can extend to rural areas and adapt animal testing to human testing)
Neuroinformatics (larger, more diverse sample sizes and more sensitive to individual differences)
Developing tests in different languages that are normed on that culture

What is the issue with using validity tests on those with dementia?

Dementia patients are usually excluded from validity test norms and there are high false positive errors, they do not correctly classify those with dementia

When can PVTs be interpreted as noncredible, invalid, or implausible?

When there is evidence of negative response bias

What formats are SVTs in?

Free standing and embedded self-reports

How does failure on SVTs occur?

When there is overreporting or an atypical report

Does failure on PVTs predict failure on SVTs or vice versa?

No, they do not predict failures on each other

When is a SVT deemed noncredible or uninterpretable?

If assessment findings identify atypical or implausible severity in the medical records, facts of the case, or SVT performance

When is a SVT considered invalid?

when there are differences between an examinee's demeanor and presentation when being observed versus their medical record, SVTs, and observations

Should SVTs be domain specific?

Yes

Does a single invalid PVT indicate malingering in a large battery?

no, need to look at all details to make a determination

Do people with cognitive impairment fail multiple PVTs?

No, the only exception is those with dementia or similar impairments to it