Psychological Assessment: Clinical & Forensic

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Malingering Research Update -- Part 3

Kenneth S. Pope, Ph.D., ABPP

Seashore Rhythm Test (see Halstead-Reitan Neuropsychological Test Battery)

 

Speech Sounds Perception Test(see Halstead-Reitan Neuropsychological Test Battery)

 

Structured Inventory of Malingered Symptomatology (SIMS)

"Basic knowledge of psychopathology does not undermine the efficacy of the Structured Inventory of Malingered Symptomatology (SIMS) to detect feigned psychosis" by M. Jelicic, M. J. V. Peters, V. Leckie, & H. Merckelbach. Netherlands Journal of Psychology, September 2007, vol. 63, #3, pages 107-110.

Summary: "The SIMS was administered twice to participants without knowledge of psychopathology (n = 30) and participants with a basic knowledge of psychopathology (n = 31). On one occasion, they had to fill out the SIMS honestly. On the other occasion they were asked to complete the SIMS after they had been instructed to malinger psychosis because they were standing trial for a serious offence and wanted to avoid legal responsibility. Participants with knowledge of psychopathology engaged in less flagrant feigning on the SIMS than those without such knowledge. However, when asked to malinger psychosis, nearly all participants were classified by the SIMS as malingerers, regardless of their knowledge of psychopathology. It seems that a basic knowledge of psychopathology does not undermine the efficacy of the SIMS to detect feigned psychosis."

"Cognitive underperformance and symptom over-reporting in a mixed psychiatric sample" by Dandachi-FitzGerald, B., R. W. H. M. Ponds, et al. The Clinical Neuropsychologist, 2011, 25(5), pages 812-828.

Summary: “The current study examined the prevalence of cognitive underperformance and symptom over-reporting in a mixed sample of psychiatric patients.... A total of 34% of them failed the ASTM, the SIMS or both tests. ASTM and SIMS scores were significantly, albeit modestly, correlated with each other.... As to the links between underperformance, over-reporting, neuropsychological tasks, and the SCL-90, the association between over-reporting on the SIMS and SCL-90 scores was the most robust one. The subsample that only failed on the ASTM performed significantly worse on a compound index of memory performance. Our findings indicate that underperformance and over-reporting are loosely coupled dimensions and that particularly over-reporting is intimately linked to heightened SCL-90 scores.”

"Detecting coached feigning using the Test of Memory Malingering (TOMM) and the Structured Inventory of Malingered Symptomatology (SIMS)" by Jelicic, M., E. Ceunen, et al. Journal of Clinical Psychology, 2011, 67(9), pages 850-855.

Summary: “Undergraduate students were administered the Test of Memory Malingering (TOMM) and the Structured Inventory of the Malingered Symptomatology (SIMS) and asked to respond honestly, or instructed to feign cognitive dysfunction due to head injury.... Results show that, although the accuracy of both instruments appears to be somewhat reduced by a mix of symptom coaching and test coaching, the TOMM and SIMS are relatively resistant to different kinds of coaching.”

"Detection of feigned cognitive dysfunction using special malinger tests: A simulation study in naïve and coached malingerers" by M. Jelicic, H. Merckelbach, I. Candel, & E. Geraerts. International Journal of Neuroscience, August, 2007, vol. 117, #8, pages 1185-1192.

Summary: "Ninety undergraduate students were administered the ASTM and the SIMS and asked to respond honestly (controls; n = 30), or instructed to malinger cognitive dysfunction due to head injury. Before the both instruments were administered, naïve malingerers received no further information (n = 30), whereas coached malingerers were given some information about brain injury and a warning not to exaggerate symptoms (n = 30). Both tests correctly classified 90% of the naïve malingerers. The ASTM detected 70% of the coached malingerers, whereas the SIMS continued to detect 90% of them. The findings suggest that coaching undermines the diagnostic accuracy of the ASTM, but does not seem to influence the accuracy of the SIMS."

"Detection of feigned crime-related amnesia: A multi-method approach" by Giger, P., T. Merten, et al. Journal of Forensic Psychology Practice, 2010, 10(5), pages 440-463.

Summary: “Sixty participants were assigned to three conditions: responding honestly; feigning crime-related amnesia; feigning amnesia with a warning not to exaggerate. High sensitivity and specificity were obtained for the Structured Inventory of Malingered Symptomatology, the Amsterdam Short-Term Memory Test, and the Morel Emotional Numbing Test. Only three warned malingerers went undetected. The results demonstrate that validated instruments exist to support forensic decision making about crime-related amnesia. Yet, warning may undermine their effectiveness, even when using a multi-method approach.”

"Detection of Feigned Psychosis with the Structured Inventory of Malingered Symptomatology (SIMS): A Study of Coached and Uncoached Simulators" by Marko Jelicic, Annemarie Hessels, & Harald Merckelbach. Journal of Psychopathology and Behavioral Assessment March, 2006, vol. 28, #1, pages 19-22.

Summary: Administered the SIMS and filler questionnairesto 60 undergraduates, asking some to complete the questionnaire honestly and other to fake psychosis as if they were standing trail facing a serious charge. "Before they completed the SIMS, instructed malingerers either received no further information (naïve malingerers; n=15), some information about psychotic symptoms (informed malingerers; n=15), or some information about psychosis and a warning not to exaggerate symptoms (coached malingerers; n=15). Even in the group of coached malingerers, the SIMS had acceptable sensitivity and specificity rates."

"Detection of malingering in psychiatric unit and general population prison inmates: A comparison of the PAI, SIMS, and SIRS" by J. F. Edens, N. G. Poythress, M. M. Watkins-Clay. Journal of Personality Assessment, February, 2007, vol. 88, #1, pages 33-42.

Summary: This study "compared the utility of three instruments, the Personality Assessment Inventory (PAI; Morey, 1991), the Structured Inventory of Malingered Symptomatology (Smith & Burger, 1997), and the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992) to detect malingering among prisoners. We examined 4 inmate samples: (a) prisoners instructed to malinger, (b) "suspected malingerers" identified by psychiatric staff, (c) general population control inmates, and (d) psychiatric patients. Intercorrelations among the measures for the total sample (N = 115) were quite high, and receiver operating characteristic analyses suggested similar rates of overall predictive accuracy across the measures. Despite this, commonly recommended cut scores for these measures resulted in widely differing rates of sensitivity and specificity across the subsamples. Moreover, although all instruments performed well in the nonpsychiatric samples (i.e., simulators and controls), classification accuracy was noticeably poorer when attempting to differentiate between psychiatric patients and suspected malingerers, with only 2 PAI indicators significantly discriminating between them."

"Diagnostic accuracy of the Structured Inventory of Malingered Symptomatology (SIMS) in detecting instructed malingering" by Harold Merckelbach & Glenn Smith. Archives of Clinical Neuropsychology, March, 2003, 18, pages 145-152.

Summary: Examined the Dutch translation of the Structured Inventory of Malingered Symptomatology, finding "that undergraduate students instructed to simulate pathology display higher SIMS scores than either normal controls or psychiatric inpatients. Data pooled over several samples (n=298) yielded sensitivity, specificity, and positive predictive power (PPP) rates that were all relatively high (>=0.90)."

"Evaluation of malingering screens with competency to stand Trial patients: A known-groups comparison" by M. Vitacco, R. Rogers, J. Gabel, & J. Munizza. Law and Human Behavior, June 2007, vol. 31, #3, pages 249-260.

Summary: "The current study assessed the effectiveness of three common screening measures: the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001), the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2004), and the Evaluation of Competency to Stand Trial-Revised Atypical Presentation Scale (ECST-R ATP; Rogers, Tillbrook, & Sewell, 2004). Using the Structured Interview of Reported Symptoms (SIRS) as the external criterion, 100 patients involved in competency to stand trial evaluations were categorized as either probable malingerers (n = 21) or nonmalingerers (n = 79). Each malingering scale produced robust effect sizes in this known-groups comparison. Results are discussed in relation to the comprehensive assessment of malingering within a forensic context."

"Screening for feigned psychiatric symptoms in a forensic sample by using the MMPI-2 and the Structured Inventory of Malingered Symptomatology" by Jason Lewis, Andrew Simcox, & David Berry. Psychological Assessment, June, 2002, pages 170-176.

Summary: Reports results of administering the Structured Interview of Reported Symptoms (SIRS), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and the Structured Inventory of Malingered Symptomatology (SIMS) to 55 men in the midst of pretrial forensic assessments for criminal responsibility or competence to stand trial. "On the basis of results from the SIRS, 31 were classified as honest responders and 24 as feigning. Significant differences between the 2 groups were found on all SIMS scales as well as on all tested MMPI-2 fake bad validity scales. The SIMS total score and the MMPI-2 Backpage Infrequency (Fb) scale had relatively high negative predictive power (100% and 92%, respectively)."

"Screening for feigning in a civil forensic setting" by Y. R. Alwes, J. A. Clark, D. T. R. Berry, & R. P. Granacher. Journal of Clinical and Experimental Neuropsychology, February, 2008, vol 30, #2, pages 1-8.

Summary: "This study compared the effectiveness of the Structured Inventory of Malingered Symptoms (SIMS; Widows & Smith, 2005) and the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) at screening for feigned psychiatric and neurocognitive symptoms in 308 individuals undergoing neuropsychiatric evaluation for workers' compensation or personal injury claims. Evaluees were assigned to probable feigning or honest groups based on results from well-validated, independent procedures. Both tests showed statistically significant discrimination between probable feigning and honest groups. Additionally, both the M-FAST and SIMS had high sensitivity and negative predictive power when discriminating probable psychiatric feigning versus honest groups, suggesting effectiveness in screening for this condition. However, neither of the procedures was as effective when applied to probable neurocognitive feigners versus honest groups, suggesting caution in their use for this purpose."

"Utility of the Structured Inventory of Malingered Symptomatology (SIMS) and the Assessment of Depression Inventory (ADI) in screening for malingering among outpatients seeking to claim disability" by Carl Clegg, William Fremouw, & Neil Mogge. Journal of Forensic Psychiatry & Psychology, April, 2009, vol. 20, #2, pp. 239-254.

Summary: "A sample of 56 disability seekers were administered the Structured Interview of Reported Symptoms (SIRS), the Structured Inventory of Malingered Symptomatology (SIMS), and the Assessment of Depression Inventory (ADI). Individuals were classified as honest or suspected malingerers based on their SIRS scores. Additionally, 60 individuals from the community completed the SIMS and the ADI honestly or as if they were malingering depression. Both malingering groups had significantly higher mean scores on the SIMS total and ADI feigning scales than both honest groups. The scores of the malingering groups did not significantly differ. The utility of various cut-off scores on these scales is presented and discussed. In the clinical sample, previously recommended SIMS total cut-off scores (>14 or >16) had excellent sensitivity, but low specificity. Conversely, the recommended ADI feigning cut-off score (>13) had excellent specificity, but low sensitivity. Increasing the SIMS total cut-off score to >19 and decreasing the ADI feigning cut-off score to >9 may improve their utility in screening for malingering among outpatients seeking to claim disability."

Symptom Validity Scale (SVS)

"Reducing the probability of false positives in malingering detection of Social Security disability claimants" by M. Chafetz. The Clinical Neuropsychologist, 2011, 25(7), pages 1239-1252.

Summary: “The Symptom Validity Scale (SVS) for low-functioning individuals (Chafetz, Abrahams, & Kohlmaier, 2007) employs embedded indicators within the Social Security Psychological Consultative Examination (PCE) to derive a score validated for malingering against two criterion tests: Test of Memory Malingering (TOMM) and Medical Symptom Validity Test (MSVT). When any symptom validity test is used with Social Security claimants there is a known rate of mislabeling (1-specificity), essentially calling a performance biased (invalid) when it is not, also known as a false-positive error. The great costs of mislabeling an honest claimant necessitated the present study, designed to show how multiple positive findings reduce the potential for mislabeling. This study utilized a known-groups design to address the impact of using multiple embedded indicators within the SVS on the diagnostic probability of malingering. Using four SVS components, Sequence, Ganser, and Coding errors, along with Reliable Digit Span (RDS), the positive predictive power was computed directly or by the chaining of likelihood ratios. The posterior probability of malingering increased from one to two to three failed indicators. With three failed indicators, there were essentially no false positive errors, and the total SVS score was in the range consistent with Definite Malingering, as shown in Chafetz et al. (2007).”

Test of Melingered Incompetence (TOMI)

"Assessing feigned cognitive impairment in defendants hospitalized for competency restoration: Further validation of the TOMI" by Colwell, L. H. and K. Colwell. Journal of Forensic Psychology Practice, 2011, 11(4), pages 293-310.

Summary: “Using three independent external criteria—the Test of Memory Malingering (TOMM) Trial 2 score, TOMM Retention Trial score, and a clinical treatment team decision—and these combined criteria—the Legal Knowledge scale (TOMI-L) evidenced high levels of sensitivity and specificity and excellent negative predictive power (NPP). The General Knowledge scale (TOMI-G) demonstrated poor sensitivity but high specificity and NPP.”

"The Test of Malingered Incompetence (TOMI): A forced-choice instrument for assessing cognitive malingering in competence to stand trial evaluations" by Colwell, Kevin; Colwell, Lori H.; Perry, Ashlie T.; Wasieleski, David; & Billings, Tod. American Journal of Forensic Psychology, 2008, vol. 26, #3, pages 17-42.

Summary: "The TOMI consists of two 25-item, two-alternative, forced-choice scales--General Knowledge (TOMI-G) and Legal Knowledge (TOMI-L)-- designed to detect malingered cognitive impairment in CST evaluations. The TOMI was derived and validated with a university sample (N = 242), with a cut score of < 21 providing maximum classification accuracy of honest and dishonest respondents. Subsequently, the TOMI was administered to forensic inpatient residents (N = 30) and was compared to existing, well-established tests of malingering (the Rey-FIT and the TOMM). Results indicated strong correlations and predictive agreement for both scales, and distinction between honest and probable dishonest respondents for the TOMI-L. A third study provided additional validation for the TOMI in distinguishing honest from dishonest student respondents (N = 120) and examined the effects of motivation on response style. For dishonest responders, those in the high motivation group scored significantly lower than those in the low motivation group, further betraying their dishonesty."

Test of Memory Malingering (TOMM)

"Assessing feigned cognitive impairment in defendants hospitalized for competency restoration: Further validation of the TOMI" by Colwell, L. H. and K. Colwell. Journal of Forensic Psychology Practice, 2011, 11(4), pages 293-310.

Summary: “Using three independent external criteria—the Test of Memory Malingering (TOMM) Trial 2 score, TOMM Retention Trial score, and a clinical treatment team decision—and these combined criteria—the Legal Knowledge scale (TOMI-L) evidenced high levels of sensitivity and specificity and excellent negative predictive power (NPP). The General Knowledge scale (TOMI-G) demonstrated poor sensitivity but high specificity and NPP.”

"Children and the test of memory malingering: is one trial enough?" Perna, R. B. and A. R. Loughan (2013). Child Neuropsychol 19(4): 438-447.

Summary: "These findings suggest that in this sample, the children who performed above the Trial 2 cutoff on Trial 1 also all passed Trial 2 (so there were no false negatives, thus a perfect sensitivity and negative predictive value). Of the 36% of children who did not pass the Trial 1 cutoff, 67% passed on Trial 2. Data clearly support that children passing Trial 1 have a high likelihood of passing Trial 2, thus drawing conclusions about performance validity after passing Trial 1. Conclusions after failing Trial 1 require further investigation."

"Comparison of computerized versus booklet versions of the TOMM" by Vanderslice-Barr, J. L., A. S. Miele, et al. Applied Neuropsychology, 2011, 18(1), pages 34-36.

“This study examined whether there is a significant difference in performance on two different versions of the Test of Memory Malingering (TOMM; Tombaugh, 1996). Differences in performance were compared between the examiner-administered booklet version versus the self-administered computerized version. No statistically significant differences were found between performance on the two versions. These data indicate that the two versions of the TOMM produce equivalent performance, at least among college students.”

"Comparison between the Test of Memory Malingering (TOMM) and the Nonverbal Medical Symptom Validity Test (NV-MSVT) in adults with disability claims" by Paul Green. Applied Neuropsychology, 2011, 18(1), pages 18-26.

Summary: “In this study, the Nonverbal Medical Symptom Validity Test (NV-MSVT; Green, 2008) and the Test of Memory Malingering (TOMM; Tombaugh, 1996) were given to a consecutive series of outpatients undergoing disability assessment. No cases of moderate to severe traumatic brain injury (TBI) failed the easy NV-MSVT subtests or the TOMM. However, 26% of the mild TBI group failed the NV-MSVT and 10% failed the TOMM. More than 10% of the whole sample passed the TOMM but failed the NV-MSVT. Using profile analysis, the NV-MSVT has been shown to have a zero false-positive rate in three independent groups of patients with severe cognitive impairment arising from dementia. The more severe the actual cognitive impairment, the more likely it is that false positives for poor effort will occur. Therefore, using the same criteria, we would also expect zero false positives in people with much less severe impairment, such as mild TBI. Those in the current study who passed the TOMM and failed the NV-MSVT had profiles that were not characteristic of people with actual severe impairment. Instead, they were of the paradoxical type seen in simulators. The results suggest that the NV-MSVT is considerably more sensitive to poor effort than the TOMM, if the conventional cutoff is used to define TOMM failure.”

"Comparison of three tests to detect feigned amnesia: The effects of feedback and the measurement of response latency" by Barbara Bolan, Jonathan Foster, Ben Schmand, & Steve Bolan. Journal of Clinical & Experimental Neuropsychology, April, 2002, pages 154-167.

Summary: Reported 3 experiments assessing the effectiveness of an English version of the "Amsterdam Short Term Memory Test (ASTM test) developed to detect feigned memory impairment. . . . Using a simulation design, the ASTM test compared favorably with the Test of Memory Malingering (TOMM) and appeared better than a newly-devised Digit Recognition Test (DRT)."

"Comparison of WMT, CARB, and TOMM failure rates in non-head injury disability claimants" by Roger Gervais, Martin Rohling, Paul Green, and Wendy Ford, Wendy. Archives of Clinical Neuropsychology, June, 2004, vol. 19, #4, pages 475-487.

Summary: This study examined 519 claimants who were referred for disability or personal injury related assessments. They "were administered three SVTs, one based on digit recognition (Computerized Assessment of Response Bias, CARB), one using pictorial stimuli (Test of Memory Malingering, TOMM) and one employing verbal recognition memory (Word Memory Test, WMT). More than twice as many people failed the WMT than TOMM. CARB failure rates were intermediate between those on the other two tests. Thus, tests of recognition memory using digits, pictorial stimuli or verbal stimuli, all of which are objectively extremely easy tasks, resulted in widely different failure rates. This suggests that, while these tests may be highly specific, they vary substantially in their sensitivity to response bias."

"Coverage of the test of memory malingering, victoria symptom validity test, and word memory test on the internet: Is test security threatened?" by Lyndsey Bauer & Robert McCaffrey. Archives of Clinical Neuropsychology, January, 2006, vol. 21, #1, pages121-126.

Summary: This study looked at "Internet coverage of SVTs because it is potentially another source of coaching, or information that is readily available. Google searches were performed on the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Word Memory Test. Results indicated that there is a variable amount of information available about each test that could threaten test security and validity should inappropriately interested parties find it."

"Daubert, Cognitive Malingering, and Test Accuracy" by Douglas Mossman. Law & Human Behavior, June, 2003, pages 229-249.

Examining data from the TOMM as an example, this article explores general issues of test accuracy in assessing malingering. In the conclusion, the author writes: "An examination of data on TOMM's performance shows that errors in test-based judgments about malingering have at least two sources. First, malingering tests themselves, though very accurate, are likely to be imperfect, because the test results of honest responders overlap with those of test takers who are feigning or exaggerating. Even when a test result justifies a great increase in one's suspicion of malingering, some small likelihood may persist that the evaluee who produced the result was responding honestly. Second, ambiguity or imprecision is inherent in estimates of the pretest probability of malingering and the accuracy indices that characterize the malingering test. As a result, an evaluator's belief about the posttest probability of malingering is best characterized as an interval that can be calculated from (and that therefore incorporates) mathematical formulations of imprecision in base rates and accuracy indices. The Daubert decision suggests that courts scrutinize 'the known or potential rate of error' of scientific techniques that form the bases of proffered expert opinions. . . . Malingering measures usually will have many possible scores, and therefore, many possible error rates. . . . If, in making a judgment about a malingering test's 'error rate,' a court is concerned about the likelihood that an expert's conclusion is wrong, then Bayes's Theorem says the calculated error rate stems in part from the expert's pretesting information and beliefs about whether an evaluee was malingering, and from the ambiguity that results from efforts to express such information and beliefs in probabilistic terms."

"Depression and the Test of Memory Malingering" by Laura Rees, Tom Tombaugh, & Luc Boulay. Archives of Clinical Neuropsychology, July, 2001, pages 501-506.

Summary: This study of 26 people who were inpatients diagnosed with major depression found that "the TOMM is unaffected by affective state. These results, combined with those from previous research, provide converging evidence that performance on the TOMM below a cutoff score of 45 cannot be attributable to depression, neurological impairment, age or education."

"Detecting coached feigning using the Test of Memory Malingering (TOMM) and the Structured Inventory of Malingered Symptomatology (SIMS)" by Jelicic, M., E. Ceunen, et al. Journal of Clinical Psychology, 2011, 67(9), pages 850-855.

Summary: “Undergraduate students were administered the Test of Memory Malingering (TOMM) and the Structured Inventory of the Malingered Symptomatology (SIMS) and asked to respond honestly, or instructed to feign cognitive dysfunction due to head injury.... Results show that, although the accuracy of both instruments appears to be somewhat reduced by a mix of symptom coaching and test coaching, the TOMM and SIMS are relatively resistant to different kinds of coaching.”

"Detecting malingering in traumatic brain injury and chronic pain: A comparison of three forced-choice symptom validity tests" by Greve, Kevin W.; Ord, Jonathan; Curtis, Kelly L.; Bianchini, Kevin J.; & Brennan, Adrianne. Clinical Neuropsychologist, August, 2008, vol. 22, #5, pages 896-918.

Summary: "Individual and joint malingering detection accuracy of the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) was examined in traumatic brain injury (TBI; 43 non-malingering, 27 malingering) and chronic pain (CP; 42 non-malingering, 58 malingering) using a known-groups design. At published cutoffs, the PDRT and TOMM were very specific but failed to detect about 50% of malingerers; the WMT was sensitive but prone to false positive errors. ROC analyses demonstrated comparable accuracy across all three tests. Joint classification accuracy was superior to that of the individual tests."

"Detecting simulation of attention deficits using reaction time tests" by Janna Willison & Tom Tombaugh. Archives of Clinical Neuropsychology, January, 2006, vol. 21, #1, pages 41-52.

Summary: "The current study examined if a newly developed series of reaction time tests, the Computerized Tests of Information Processing (CTIP) ... were sensitive to simulation of attention deficits commonly caused by traumatic brain injury (TBI). The CTIP consists of three reaction time tests: Simple RT, Choice RT, and Semantic Search RT. These tests were administered to four groups: Control, Simulator, Mild TBI, and Severe TBI. Individuals attempting to simulate attention deficits produced longer reaction time scores, made more incorrect responses, and exhibited greater variability than cognitively-intact individuals and those with TBI. Sensitivity and specificity values were comparable or exceeded those obtained on the Test of Memory Malingering..."

"Detecting Symptom- and Test-Coached Simulators with the Test of Memory Malingering' by Matthew Powell, Jeffrey Gfeller, Bryan Hendricks, & Michael Sharland. Archives of Clinical Neuropsychology, August, 2004, vol. 19, #5, pages 693-702.

Summary: This study found that "Although the symptom-coached group performed more poorly on the TOMM relative to the test-coached group, the test was equally sensitive in detecting suboptimal effort across the different coaching paradigms."

"Detection of feigned ADHD in college students" by Sollman, M. J., J. D. Ranseen, et al. Psychological Assessment, 2010, 22(2), pages 325-335.

Summary: “The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale–Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test—II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal–Medical Symptom Validity Test), particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD.”

"Detection of malingering in a Spanish population using three specific malingering tests" by R.Vilar-López, S. Santiago-Ramajo, M. Gómez-Río, A. Verdejo-García, J. M. Llamas, M. Pérez-García. Archives of Clinical Neuropsychology, March 2007, vol. 22, #3, pages 379-388.

Summary: "Studies on the use of neuropsychological tests in ethnic groups for which they were not designed have shown variations in performance associated with cultural differences. With this background, our group studied a Spanish population by applying commonly used procedures [Victoria Symptom Validity Test (VSVT), Test of Memory Malingering (TOMM), and the b test] in a group with postconcussion syndrome (PCS) (whether litigants or not) and in a group of analog malingerers (AN). These tests appeared to function adequately in this Spanish population, who showed similar performances to results published for North Americans."

"Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting" by Ruocco, Anthony C.; Swirsky-Sacchetti, Thomas; Chute, Douglas L.; Mandel, Steven; Platek, Steven M.; &Zillmer, Eric A. Clinical Neuropsychologist, May, 2008, vol. 22, #3, pages 547-564.

Summary: "It is unclear whether symptom validity test (SVT) failure in neuropsychological and psychiatric domains overlaps. Records of 105 patients referred for neuropsychological evaluation, who completed the Test of Memory Malingering (TOMM), Reliable Digit Span (RDS), and Millon Clinical Multiaxial Inventory-III (MCMI-III), were examined. TOMM and RDS scores were uncorrelated with MCMI-III symptom validity indices and factor analysis revealed two distinct factors for neuropsychological and psychiatric SVTs. Only 3.5% of the sample failed SVTs in both domains, 22.6% solely failed the neuropsychological SVT, and 6.1% solely failed the psychiatric SVT. The results support a dissociation between neuropsychological malingering and exaggeration of psychiatric symptoms in a neuropsychological setting."

"Effect of depression and anxiety on the TOMM in community-dwelling older adults" by Lee Ashendorf, Lee, Marios Constantinou, & Robert McCaffrey. Archives of Clinical Neuropsychology, January, 2004, vol. 19, #1, pages 125-130.

Summary: Used the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) with a sample of older adults (age 55-75) to investigate whether the TOMM is affected by the presence of depression or anxiety. The authors conclude that "findings demonstrate that depression and anxiety levels in an older community-dwelling sample do not negatively affect performance on the TOMM."

"Effects of severe depression on TOMM performance among disability-seeking outpatients" by Tami Yanez, Williams Fremouw, Jennifer Tennant, Julia Strunk, & Kayla Coker. Archives of Clinical Neuropsychology, February, 2006, vol. 21, #2, pages 161-165.

Summary: "Of the 20 depressed participants, only 2 on Trial 2 and 1 on the Retention Trial scored below the cutoff of 45, while none of the control participants performed in this range.... The results indicate that the TOMM can be used with even severely depressed participants with only slight caution."

"Efficacy of Test of Memory Malingering Trial 1, Trial 2, the Retention Trial, and the Albany Consistency Index in a criterion group forensic neuropsychological sample." Schroeder, R. W., et al. (2013). Archives of Clinical Neuropsychology 28(1): 21-29.

Summary: "Recent research [on the TOMM] has suggested...that the original indices and cutoffs may require modifications to increase sensitivity rates. Some of these modifications lack cross-validation and no study has examined all indices in a single sample. This study compares Trial 1, Trial 2, the Retention Trial, and the newly created Albany Consistency Index in a criterion group forensic neuropsychological sample. Findings lend support for the newly created indices and cutoff scores."

"Effort Testing in Schizophrenia and Schizoaffective Disorder: Validity Indicator Profile and Test of Memory Malingering Performance Characteristics." Hunt, S., et al. (2013). Arch Clin Neuropsychol.

Summary: "Results indicate that the use of the VIP with psychotic-disordered individuals will generate increased invalid performance profiles, whereas the TOMM is more resilient in this population. Significantly, mental status and estimated intellectual ability were predictive of classifications on the VIP Verbal subtest and the TOMM."

"Hit Rates of Adequate Performance Based on the Test of Memory Malingering (TOMM) Trial 1" by Brandon Gavett, Sid O'Bryant, Jerid Fisher, & Robert McCaffrey. Applied Neuropsychology, 2005, vol. 12, #1, pages 1-4.

Summary: The results of this study "Findings reveal that adequate Trial 1 scores predict adequate Trial 2 and Retention Trial scores, suggesting that patients scoring 45 or greater on Trial 1 are not likely to be suspected of poor effort based on overall TOMM performance."

"How'd they do it? Malingering strategies on symptom validity tests" By Jing Tan, Daniel Slick, Esther Strauss, & David Hultsch. Clinical Neuropsychologist, December, 2002, vol. 16, #4, pages 495-505.

Summary: "Twenty-five undergraduate students were instructed to feign believable impairment following a brain injury from a car accident and 27 students were told to perform like they had recovered from such an injury on 3 "forced-choice tests, the Test of Memory Malingering (TOMM), Victoria Symptom Validity Test (VSVT), and Word Memory Test (WMT).... Test-taking strategies were evaluated by means of a questionnaire given at the end of the test session. The results revealed that all the tasks differentiated between groups. Using conventional cut-scores, the WMT proved most efficient while the VSVT captured the most participants in the definitive below-chance category. Individuals instructed to feign injury were more likely to prepare prior to the experiment, with feigning of memory loss as the most frequently reported strategy. Regardless, preparation effort did not translate into believable performance on the tests."

"Impact of Cognitive and Psychiatric Impairment of Psychotic Disorders on the Test of Memory Malingering (TOMM)" by Alexander Duncan. Assessment, June, 2005, vol. 12, #2, pages 123-129.

Summary: This study found that "Although psychotic patients with concentration problems showed greater variability across TOMM trials, both groups obtained mean scores above 45 on Trial 2 and the retention trial on the TOMM. These findings indicate that cognitive impairment associated with psychosis generally does not negatively impair TOMM performance to such a level that would produce a false positive on the TOMM."

"Malingering detection in a Spanish population with a known-groups design" by Vilar-López, Raquel; Gómez-Río, Manuel; Santiago-Ramajo, Sandra; Rodríguez-Fernández, Antonio; Puente, Antonio E.; & Pérez-García, Miguel. Archives of Clinical Neuropsychology, July, 2008, vol. 23, #4, pages 365-377.

Summary: "Malingering detection has become a topic of increased interest in the US over the last years. However, this development has not been matched in Europe. For example, in Spain there is insufficient evidence to support the use of reliable and valid malingering tests. In this study, we tested the applicability of two malingering detection tests (Test of Memory Malingering (TOMM) and Dot Counting Test) in a Spanish sample. The sample included three groups of patients (30 non-compensation seeking, 14 compensation seeking non-suspected of malingering, and 10 suspected of malingering) and a group of analog students (n = 54). Tests' results were able to discriminate between the groups of malingerers (both patients and analogs) and non-malingerers (both compensation seeking and non-compensation seeking). However, the TOMM achieved a higher overall classification rate than the Dot Counting Test. Our results encourage the use of the TOMM as an indicator of malingering with Spanish population."

"Mediating effects of effort upon the relationship between head injury severity and cognitive functioning" by Alan Moss, Christopher Jones, Dene Fokias, & David Quinn. Brain Injury, May, 2003, vol. 17, #5, pages 377-387.

Summary: Examined potential relationship between severity of head injury (measured by duration of post-traumatic amnesia) and cognitive functioning in 78 patients, ranging from 18 to 70 years of age, who passed or failed a test of effort (the Test of Malingered Memory). "A systematic and interpretable negative correlation between head injury severity and intellectual and memory functioning was demonstrated in persons passing the test of effort. However, in persons failing the test of effort no such relationships were demonstrated."

"Neuropsychological performance in Gulf War era veterans: Motivational factors and effort" by Karen Lindem, Roberta White, Timothy Hereen, Susan Proctor, Maxine Krengel, Jennifer Vasterling, Jessica Wolfe, Patricia Sutker, Shalene Kikley, & Terence Keane. Journal of Psychopathology & Behavioral Assessment, June, 2003, vol. 25, #2, pages 129-138.

Summary: Used the TOMM to assess the relationship between motivation to do well on neuropsychological tests and actual neurological test performance among 77 Gulf War era veterans. "Most veterans earned perfect or near-perfect scores on the TOMM (48-50/50). Scores <=47 were associated with lower scores on neuropsychological tasks assessing attention, executive functions, and memory . Variability in test performance within and between tasks measuring similar functions was also found in participants with lower TOMM scores."

"Neuropsychological test performance of successful brain injury simulators" by J. W. DenBoer & S. Hall, Stuart. Clinical Neuropsychologist, November 2007, vol. 21, #6, pages 943-955.

Summary: "Coached (n = 56) and uncoached (n = 35) brain injury simulators received instructions to fake cognitive impairment; controls were asked to do their best. The Test of Memory Malingering (TOMM) was administered along with standard neuropsychological measures (e.g., Wisconsin Card Sorting Test). The TOMM identified 80% of uncoached and 60% of coached brain injury simulators. SBIS were participants from the brain injury simulation groups whose TOMM performance indicated adequate effort. A total of 32% of all brain injury simulators scored above the TOMM cutoff scores for adequate effort (the SBIS group). Significantly more coached than uncoached participants composed the SBIS group (76% vs. 24%, respectively). SBIS performed significantly worse than controls and significantly better than unsuccessful brain injury simulators on select standard neuropsychological measures. The SBIS scores were lowered compared to controls; in some instances this lowered performance was at a clinically relevant level."

"The performance of juvenile offenders on the test of memory malingering" by Julianne Gast & Kathleen Hart. Journal of Forensic Psychology Practice, vol. 10, #1, 2010, pages 53-68.

Summary: "The present study investigated the TOMM performance of adolescents who are involved in the juvenile court system. Their performance was compared against adult normative data and analyzed by levels of intellectual functioning. Overall, the adolescents performed at levels that have been found in adult community samples, thus indicating that adult norms for the TOMM can be used with adolescents of a wide range of intellectual functioning."

"Performance of mentally retarded forensic patients on the Test of Memory Malingering" by M. J. Simon. Journal of Clinical Psychology, April 2007, vol. 63, #4, pages 339-344.

Summary: "wenty-one adjudicated forensic inpatients, who had been diagnosed with mental retardation, were administered the TOMM. The majority of these patients also suffered from an Axis I mental disorder. The participants attained a mean score of 48.7 on Trial 2, with only 1 participant scoring below the standard cutoff for malingering (i.e., 45). The participants attained a mean score of 49.4 on the Retention Trial, with no participants falling below the cutoff for malingering. The results clearly indicate that mildly retarded forensic patients can perform well on the TOMM. The findings provide evidence that the TOMM can be used in the assessment of mildly retarded criminal defendants with little fear of obtaining false indications of malingering."

"Performance on the Test of Memory Malingering (TOMM) among a large clinic-referred pediatric sample" by Kirk, J. W., B. Harris, et al. Child Neuropsychology, 2011, 17(3), pages 242-254.

Summary: “The findings suggest that children perform similarly to adults on the TOMM and that the TOMM is appropriate for use with pediatric clinical populations as young as 5 years.

"Performance On The Test Of Memory Malingering In A Mixed Pediatric Sample" by Jacobus Donders. Child Neuropsychology, April, 2005, pages 221-227.

Summary: This study assessed the TOMM on "a sample of 100 consecutively referred 6 to 16-year-old children with a wide range of clinical diagnoses. In the complete sample, 97 children met actuarially defined criteria for sufficient effort on the TOMM. Two children were correctly identified as providing suboptimal effort and only one case was a possible false positive. Performance on the second trial of the TOMM did not vary with gender, ethnicity, parental occupation, performance on an independent memory test, or length of coma. Although younger children tended to be somewhat less efficient on the TOMM than older children, more than 90% of children in the 6-8 years range met criteria originally developed for adults for sufficient effort on the TOMM. It is concluded that the TOMM is a potentially useful measure of effort in the clinical neuropsychological evaluation of school-age children."

"Predicting test of memory malingering and medical symptom validity test failure within a Veterans Affairs Medical Center: use of the Response Bias Scale [of the MMPI-2] and the Henry-Heilbronner Index." Arch Whitney, K. A. (2013). Clin Neuropsychol 28(3): 222-235.

Summary: "The ability of the Response Bias Scale (RBS) and the Henry-Heilbronner Index (HHI), along with several other MMPI-2 validity scales, to predict performance on two separate stand-alone symptom validity tests, the Test of Memory Malingering (TOMM) and the Medical Symptom Validity Test (MSVT), was examined. Findings from this retrospective data analysis of outpatients seen within a Veterans Affairs medical center (N = 194) showed that group differences between those passing and failing the TOMM were largest for the RBS (d = 0.79), HHI (d = 0.75), and Infrequency (F; d = 0.72). The largest group differences for those passing versus failing the MSVT were greatest on the HHI (d = 0.83), RBS (d = 0.80), and F (d = 0.78). Regression analyses showed that the RBS accounted for the most variance in TOMM scores (20%), whereas the HHI accounted for the most variance in MSVT scores (26%). Nonetheless, due to unacceptably low positive and negative predictive values, caution is warranted in using either one of these indices in isolation to predict performance invalidity."

Sensitivity of the Test of Memory Malingering and the Nonverbal Medical Symptom Validity Test: A replication study" by Armistead-Jehle, P. and R. Gervais. Applied Neuropsychology, 2011,18(4), pages 284-290.

Summary: “Nearly twice as many examinees failed the NV-MSVT than the TOMM. Profile analyses of the NV-MSVT demonstrated patterns suggestive of inconsistent effort in those who failed the NV-MSVT but passed the TOMM. A classification analysis employing the Word Memory Test and Medical Symptom Validity Test as external criteria for poor effort showed that the NV-MSVT is substantially more sensitive to poor effort than the TOMM and maintains an acceptable false-positive rate.”

"Should the retention trial of the test of memory malingering be optional?" by Kevin Greve and Kevin Bianchini. Archives of Clinical Neuropsychology, January, 2006, vol. 21, #1, pages 117-119.

Summary: This study examined how optional use of the TOMM Retention trial could affect the false negative rate. "TOMM scores from 150 traumatic brain injury and 150 chronic pain patients were examined. Results indicated that early termination of the TOMM resulted in 3% of patients going undetected by the TOMM. The practical cost of this error was minimized by the inclusion of at least one other SVT."

"Test of Malingered Incompetence (TOMI): A forced-choice instrument for assessing cognitive malingering in competence to stand trial evaluations" by Colwell, Kevin; Colwell, Lori H.; Perry, Ashlie T.; Wasieleski, David; & Billings, Tod. American Journal of Forensic Psychology, 2008, vol. 26, #3, pages 17-42.

Summary: "The TOMI consists of two 25-item, two-alternative, forced-choice scales--General Knowledge (TOMI-G) and Legal Knowledge (TOMI-L)-- designed to detect malingered cognitive impairment in CST evaluations. The TOMI was derived and validated with a university sample (N = 242), with a cut score of < 21 providing maximum classification accuracy of honest and dishonest respondents. Subsequently, the TOMI was administered to forensic inpatient residents (N = 30) and was compared to existing, well-established tests of malingering (the Rey-FIT and the TOMM). Results indicated strong correlations and predictive agreement for both scales, and distinction between honest and probable dishonest respondents for the TOMI-L. A third study provided additional validation for the TOMI in distinguishing honest from dishonest student respondents (N = 120) and examined the effects of motivation on response style. For dishonest responders, those in the high motivation group scored significantly lower than those in the low motivation group, further betraying their dishonesty."

"Test of memory malingering: cutoff scores for psychometrically defined malingering groups in a military sample." Jones, A. (2013). Clin Neuropsychol 27(6): 1043-1059.

Summary: "Positive likelihood ratios were all above 10 for these two trials indicating excellent ability to rule in malingering. A range of cutoffs for Trial 1 were also examined, and classification and diagnostic statistics are presented for cutoffs ranging from 40 to 44 with results similar to the other TOMM trials."

"Test of Memory Malingering Performance is unaffected by laboratory-induced pain: Implications for clinical use" by Joseph Etherton, Kevin Bianchini, Kevin Greve, Megan Ciota. Archives of Clinical Neuropsychology, May, 2005, vol. 20, #3, pages 375-384.

Summary: "Participants (n=20 per group) were administered the TOMM under one of three conditions: (1) standard instructions; (2) instructions to simulate pain-related memory deficit in pursuit of personal injury litigation; (3) while experiencing cold-induced pain. Results indicate that TOMM performance was unaffected by laboratory-induced moderate to severe pain and support the TOMM's use in evaluating clinical patients with pain."

"Test of Memory Malingering (TOMM) in forensic psychology" by Tom Tombaugh. Journal of Forensic Neuropsychology, 2002, 2, pages 69-96.

Summary: Describes the Test of Memory Malingering (TOMM) and presents data from 5 studies to assess the TOMM's sensitivity to faking memory impairment.

"Test of Memory Malingering (TOMM): Normative data from cognitively intact, cognitively impaired, and elderly patients with dementia" by Gordon Teichner & Mark Wagner. Archives of Clinical Neuropsychology, April, 2004, vol. 19, #3, pages 455-464.

Summary: This study of the Tomm with cognitively intact, cognitively impaired, and elderly patients wiith dementia found that "the TOMM is a useful index for detecting the malingering of memory deficits, even in patients with cognitive impairment, but only when dementia can be ruled out."

"Use of the TOMM in a criminal court forensic assessment setting" by Sheryl Delain, Kathleen Stafford, & Yossef Ben-Porath. Assessment, December, 2003, vol. 10, #4, pages 370-381.

Summary: Examined use of the Test of Memory Malingering (TOMM) in a criminal court forensic setting. Among their findings, the authors report that "defendants whose TOMM scores met the recommended criteria for detecting malingering (n=29) were more likely to report a previous head injury, to be viewed as only marginally cooperative or uncooperative during the course of the evaluation, and to be diagnosed with antisocial personality disorder than those who did not generate suspicious TOMM scores."

"Use of trial 1 of the Test of Memory Malingering (TOMM) as a screening measure of effort: Suggested discontinuation rules" by Hilsabeck, R. C., S. N. Gordon, et al. The Clinical Neuropsychologist, 2011, 25(7), pages 1228-1238.

Summary: “A total of 229 veterans were administered the TOMM as part of a neuropsychological evaluation. Trial 1 scores ≥41 and ≤25 showed good utility as discontinuation scores for adequate and poor effort, respectively, beyond which administration of additional trials were unnecessary. Findings suggest better Trial 1 performance is significantly related to better speeded mental flexibility and memory.”

"Using symptom validity tests to detect malingered ADHD in college students" by Jasinski, L. J., J. P. Harp, et al. The Clinical Neuropsychologist, 2011, 25(8), pages 1415-1428.

Summary: “Undergraduates with a history of diagnosed ADHD were randomly assigned either to respond honestly or exaggerate symptoms, and were compared to undergraduates with no history of ADHD or other psychiatric disorders who were also randomly assigned to respond honestly or feign symptoms of ADHD. Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD. When considered as a group, the criterion of failure of 2 or more of these SVTs had a sensitivity of. 475 and a specificity of 1.00.”

"Using the TOMM for evaluating children's effort to perform optimally on neuropsychological measures" by Marios Constantinou & Robert McCaffrey. Child Neuropsychology, June, 2003, pages 81-90.

Summary: The study involved administering the Test of Memory Malingering (TOMM) and the Rey-15-item test to 128 children ranging from 5 to 12 years old. "The results indicated that the TOMM has the potential to be used as a measure for identifying children who do not put forth maximal effort during neuropsychological evaluations. In contrast, the Rey-15-item test does not appear to be a promising measure of effort for use with children, especially younger children."

"Validation of the Test of Memory Malingering in a Forensic Psychiatric Setting" by Michael Weinborn, Tamara Orr, Steven Woods, Emily Conover, & Jeffrey, Feix. Journal of Clinical & Experimental Neuropsychology, October, 2003, vol. 25, #7, pages 979-990.

Summary: Compared 25 inpatients admitted for assessment of Competency to Stand Trial (CST/MSO group) and 36 patients adjudicated Not Guilty By Reason of Insanity or civilly committed (CIVIL/NGRI). "ignificantly more CST/MSO patients (36%) scored below a recommended TOMM cutoff score relative to CIVIL/NGRI patients (6%). Findings indicate excellent specificity and modest sensitivity, and generally support the validity of the TOMM in a forensic psychiatric population."

"WAIS-IV digit Span variables: Are they valuable for use in predicting TOMM and MSVT failure?" Whitney, K. A., et al. (2013). Applied Neuropsychology: Adult 20(2): 83-94.

Summary: "Findings from this retrospective analysis showed that, regardless of whether the TOMM or the MSVT was used as the negative response bias criterion, of all the DS variables examined, DS Sequencing Total showed the best classification accuracy. Yet, due to its relatively low positive and negative predictive power, DS Sequencing Total is not recommended for use in isolation to identify negative response bias."

"What Tests Are Acceptable for Use in Forensic Evaluations? A Survey of Experts" by Stephen Lally. Professional Psychology: Research & Practice, October, 2003, vol. 34, #5, pages 491-498.

Surveyed diplomates in forensic psychology "regarding both the frequency with which they use and their opinions about the acceptability of a variety of psychological tests in 6 areas of forensic practice. The 6 areas were mental state at the offense, risk for violence, risk for sexual violence, competency to stand trial, competency to waive Miranda rights, and malingering." In regard to the forensic assessment of malingering, "the majority of the respondents rated as acceptable the Structured Interview of Reported Symptoms (SIRS), Test of Memory Malingering, Validity Indicator Profile, Rey Fifteen Item Visual Memory Test, MMPI-2, PAI, WAIS-III, and Halstead-Reitan. The SIRS and the MMPI-2 were recommended by the majority. The psychologists were divided between acceptable and unacceptable about using either version of the MCMI (II or III). They were also divided, although between acceptable and no opinion, for the WASI, KBIT, Luria-Nebraska, and Stanford-Binet-Revised. The diplomates viewed as unacceptable for evaluating malingering the Rorschach, 16PF, projective drawings, sentence completion, and TAT. The majority gave no opinion on the acceptability of the Malingering Probability Scale, M-Test, Victoria Symptom Validity Test, and Portland Digit Recognition Test."

Test of Variable Attention (TOVA)

"Probable Malingering and Performance on the Test of Variables of Attention" by George Henry. Clinical Neuropsychologist, February, 2005, vol. 19, #1, pages 121-129.

Summary: In this study, 50 participants " with mild head injury involved in personal injury litigation and 2 subjects referred for evaluation of their disability status underwent comprehensive neuropsychological examination including the Test of Variables of Attention (TOVA). Group status was determined by performance on symptom validity testing. Twenty-six subjects who failed symptom validity testing formed the probable malingering (PM) group, while 26 subjects who passed symptom validity testing comprised the not malingering (NM) group. Subjects in the PM group performed significantly worse on all TOVA variables relative to subjects in the NM group. Discriminant function analyses revealed that TOVA omission errors ≥3 errors was the best predictor of group status."

Trail Making Test

Please see Halstead-Reitan Neuropsychological Test Battery Validity Indicator Profile.

Traumatic Symptom Inventory (TSI)

"Evaluation of the Atypical Response Scale of the Trauma Symptom Inventory?-?2 in detecting simulated posttraumatic stress disorder" by Matt Gray, Jon Elhai, & John Briere. Journal of Anxiety Disorders, vol 24, #5, June 2010, pages 447-451.

Summary: "This investigation evaluated the Atypical Response (ATR) scale of the Trauma Symptom Inventory—2nd edition (TSI-2) in terms of its ability to distinguish genuine symptoms of posttraumatic stress disorder (PTSD) from simulated PTSD. Seventy-five undergraduate students were trained to simulate PTSD and were given monetary incentives to do so. Their responses on the PTSD Checklist (PCL), TSI-2 ATR, and Personality Assessment Inventory (PAI) validity scales were compared to responses of 49 undergraduate students with genuine symptoms of PTSD instructed to respond honestly on testing. Results indicate that the revised version of the ATR is superior to the original version in detecting malingered PTSD. Discriminant Function Analyses revealed correct classification of 75% of genuinely distressed individuals and 74% of PTSD simulators."

"Impact of Coaching on Malingered Posttraumatic Stress Symptoms on the M-FAST and the TSI" by Jennifer Guriel, Tami Yañez, William Fremouw, Andrea Shreve-Neiger, Lisa Ware, Holly Filcheck, & Chastity Farr. Journal of Forensic Psychology Practice, 2004, vol. 4, #2, pages 37-56.

Summary: This study of the responses of 68 undergraduate psychology majors found: "Unlike previous research, those who were provided with symptoms and/or symptoms and strategies were found to be no more successful at malingering PTSD than were those who were not provided with this information. While only two-thirds of the simulators were detected as malingering using the M-FAST total score or TSI validity scales, nearly 90% were identified when these measures were utilized together."

"Utility of the Trauma Symptom Inventory's Atypical Response Scale in Detecting Malingered Post-Traumatic Stress Disorder" by Jon Elhai, Matthew Gray, James Naifeh, Jimmie Butcher, Joanne Davis, Sherry Falsetti, & Connie Best. Assessment, June 2005, vol. 12, #2, pages 210-219.

Summary: This study, which compared 88 students who were simulating PTSD to 48 outpatients diagnosed as suffering from PTSD, found "between-group differences on several TSI clinical scales and the Atypical Response (ATR) validity scale. Discriminant function analysis using ATR revealed 75% correct patient classification but only 48% correct simulator classification, with an overall correct classification rate of 59% (positive predictive power [PPP] = .71; negative predictive power [NPP] = .51). Individual ATR cutoff scores did not yield impressive classification results, with the optimal cutoff (T score = 61) correctly classifying only 61% of simulators and patients (PPP = .66, NPP = .54). Although ATR was not developed as a malingered PTSD screen, instead serving as a general validity screen, caution is recommended in its current clinical use for detecting malingered PTSD."

Validity Indicator Profile

"Effort Testing in Schizophrenia and Schizoaffective Disorder: Validity Indicator Profile and Test of Memory Malingering Performance Characteristics." Hunt, S., et al. (2013). Arch Clin Neuropsychol.

Summary: "Results indicate that the use of the VIP with psychotic-disordered individuals will generate increased invalid performance profiles, whereas the TOMM is more resilient in this population. Significantly, mental status and estimated intellectual ability were predictive of classifications on the VIP Verbal subtest and the TOMM."

"Review of the Validity Indicator Profile" by Richard Frederick. Journal of Forensic Neuropsychology, 2002, 2, pages 125-145.

Summary: Discusses the creation and cross-validation of the Validity Indicator Profile, a forced-choice test to identify malingering (and other misleading response styles) in cognitive and neuropsychological testing.

"What Tests Are Acceptable for Use in Forensic Evaluations? A Survey of Experts" by Stephen Lally. Professional Psychology: Research & Practice, October, 2003, vol. 34, #5, pages 491-498.

Surveyed diplomates in forensic psychology "regarding both the frequency with which they use and their opinions about the acceptability of a variety of psychological tests in 6 areas of forensic practice. The 6 areas were mental state at the offense, risk for violence, risk for sexual violence, competency to stand trial, competency to waive Miranda rights, and malingering." In regard to the forensic assessment of malingering, "the majority of the respondents rated as acceptable the Structured Interview of Reported Symptoms (SIRS), Test of Memory Malingering, Validity Indicator Profile, Rey Fifteen Item Visual Memory Test, MMPI-2, PAI, WAIS-III, and Halstead-Reitan. The SIRS and the MMPI-2 were recommended by the majority. The psychologists were divided between acceptable and unacceptable about using either version of the MCMI (II or III). They were also divided, although between acceptable and no opinion, for the WASI, KBIT, Luria-Nebraska, and Stanford-Binet-Revised. The diplomates viewed as unacceptable for evaluating malingering the Rorschach, 16PF, projective drawings, sentence completion, and TAT. The majority gave no opinion on the acceptability of the Malingering Probability Scale, M-Test, Victoria Symptom Validity Test, and Portland Digit Recognition Test."

Victoria Symptom Validity Test (VSVT)

"Coverage of the test of memory malingering, victoria symptom validity test, and word memory test on the internet: Is test security threatened?" by Lyndsey Bauer & Robert McCaffrey. Archives of Clinical Neuropsychology, January, 2006, vol. 21, #1, pages121-126.

Summary: This study looked at "Internet coverage of SVTs because it is potentially another source of coaching, or information that is readily available. Google searches were performed on the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Word Memory Test. Results indicated that there is a variable amount of information available about each test that could threaten test security and validity should inappropriately interested parties find it."

"Detection of malingering in a Spanish population using three specific malingering tests" by R.
Vilar-López, S. Santiago-Ramajo, M. Gómez-Río, A. Verdejo-García, J. M. Llamas, M. Pérez-García. Archives of Clinical Neuropsychology, March 2007, vol. 22, #3, pages 379-388.

Summary: "Studies on the use of neuropsychological tests in ethnic groups for which they were not designed have shown variations in performance associated with cultural differences. With this background, our group studied a Spanish population by applying commonly used procedures [Victoria Symptom Validity Test (VSVT), Test of Memory Malingering (TOMM), and the b test] in a group with postconcussion syndrome (PCS) (whether litigants or not) and in a group of analog malingerers (AN). These tests appeared to function adequately in this Spanish population, who showed similar performances to results published for North Americans."

"How'd they do it? Malingering strategies on symptom validity tests" By Jing Tan, Daniel Slick, Esther Strauss, & David Hultsch. Clinical Neuropsychologist, December, 2002, vol. 16, #4, pages 495-505.

Summary: "Twenty-five undergraduate students were instructed to feign believable impairment following a brain injury from a car accident and 27 students were told to perform like they had recovered from such an injury on 3 "forced-choice tests, the Test of Memory Malingering (TOMM), Victoria Symptom Validity Test (VSVT), and Word Memory Test (WMT).... Test-taking strategies were evaluated by means of a questionnaire given at the end of the test session. The results revealed that all the tasks differentiated between groups. Using conventional cut-scores, the WMT proved most efficient while the VSVT captured the most participants in the definitive below-chance category. Individuals instructed to feign injury were more likely to prepare prior to the experiment, with feigning of memory loss as the most frequently reported strategy. Regardless, preparation effort did not translate into believable performance on the tests."

"Intraindividual variability as an indicator of malingering in head injury" by Esther, Strauss, Daniel Slick, Judi Levy-Bencheton, Michael Hunter, Stuart MacDonald, & David Hultsch. Archives of Clinical Neuropsychology, July, 2002, pages 423-444.

Summary: Analog study of malingering using the Reliable Digit Span (RDS) task, the Victoria Symptom Validity Test (VSVT), and the Computerized Dot Counting Test (CDCT). Half the participants were asked to fake an injury convincingly and the other half were asked to take the tests honestly. Findings suggest that "regardless of an individual's experience, consideration of both level of performance (particularly on forced-choice symptom validity tasks) and intraindividual variability holds considerable promise for the detection of malingering."

"Use of specific malingering measures in a Spanish sample" by Vilar-López, Raquel; Gómez-Río, Manuel; Caracuel-Romero, Alfonso; Llamas-Elvira, Jose; & Pérez-García, Miguel. Journal of Clinical and Experimental Neuropsychology, August, 2008, vol. 30, #6, pages 710-722.

Summary: "There are an increasing number of tests available for detecting malingering. However, these tests have not been validated for using in Spanish speakers. The purpose of this study is to explore the value of three specific malingering tests in the Spanish population. This study used a known-groups design, together with a group of analog students. The results show that both the Victoria Symptom Validity Test and the b Test can be used to detect malingering in Spanish population. However, some restrictions must be applied when the Rey 15-Item Test is administered and interpreted."

"Victoria Symptom Validity Test: An enhanced test of symptom validity" by Garrie Thompson. Journal of Forensic Neuropsychology, 2002, 2, pages 43-67.

Summary: Reviews studies of the Victoria Symptom Validity Test (VSVT)--a computer-administered, forced-choice test to asses malingering of cognitive impairment--in light of Daubert standards.

"What Tests Are Acceptable for Use in Forensic Evaluations? A Survey of Experts" by Stephen Lally. Professional Psychology: Research & Practice, October, 2003, vol. 34, #5, pages 491-498.

Surveyed diplomates in forensic psychology "regarding both the frequency with which they use and their opinions about the acceptability of a variety of psychological tests in 6 areas of forensic practice. The 6 areas were mental state at the offense, risk for violence, risk for sexual violence, competency to stand trial, competency to waive Miranda rights, and malingering." In regard to the forensic assessment of malingering, "the majority of the respondents rated as acceptable the Structured Interview of Reported Symptoms (SIRS), Test of Memory Malingering, Validity Indicator Profile, Rey Fifteen Item Visual Memory Test, MMPI-2, PAI, WAIS-III, and Halstead-Reitan. The SIRS and the MMPI-2 were recommended by the majority. The psychologists were divided between acceptable and unacceptable about using either version of the MCMI (II or III). They were also divided, although between acceptable and no opinion, for the WASI, KBIT, Luria-Nebraska, and Stanford-Binet-Revised. The diplomates viewed as unacceptable for evaluating malingering the Rorschach, 16PF, projective drawings, sentence completion, and TAT. The majority gave no opinion on the acceptability of the Malingering Probability Scale, M-Test, Victoria Symptom Validity Test, and Portland Digit Recognition Test."

Wechsler Adult Intelligence Scale

"Brief screening indexes for malingering: A confirmation of vocabulary minus digit span from the WAIS-III and the rarely missed index from the WMS-III" by Lori Miller, Joseph Ryan, Christine Carruthers, & Richard Cluff. Clinical Neuropsychologist, May, 2004, vol. 18, #2, pages 327-333.

Summary: In this study, the "first measure evaluated was Vocabulary (V) minus Digit Span (DS) (Mittenberg, Theroux-Fichera, Zielinski, & Heilbronner, 1995); the second measure was the Rarely Missed Index (RMI) for the WMS-III Logical Memory subtest (Killgore & Della-Pietra, 2000). V-DS misclassified 0% of individuals in the alcohol abuse group, 2% of those in the polysubstance abuse group, and 0% of head injury cases. RMI misclassification rates were 3%, 5%, and 7% for the alcohol abuse, polysubstance abuse, and head injury groups, respectively."

"Detecting malingered neurocognitive dysfunction using the Reliable Digit Span in traumatic brain injury" by Charles Mathias, Kevin Greve, Kevin Bianchini, Rebecca Houston, & John Crouch. Assessment, September, 2002, pages 301-308.

Summary: Examined the sensitivity, specificity, and predictive power of the Reliable Digit Span in regard to malingering neurocognitive dysfunction on 54 traumatic brain injury patients and a control group of 30 patients. Concluded that "classification accuracy for the RDS was excellent."

"Detecting malingered performance on the Wechsler Adult Intelligence Scale: Validation of Mittenberg's approach in traumatic brain injury" by Kevin Greve, Kevin Bianchini, Charles Mathias, Rebecca Houston, & John Crouch. Archives of Clinical Neuropsychology, April, 2003, pages 245-260.

Summary: Evaluated Mittenberg et al.'s performance validity markers on the WAIS in identifying malingered neurocognitive dysfunction . "The discriminant function score (DFS) and the vocabulary-digit span (VDS) difference score were calculated and sensitivity, specificity, and predictive power were examined for several cut-offs for each marker individually and the two combined. Classification accuracy for the DFS was acceptable and better than for VDS. The use of the two markers in combination resulted in no incremental increase in classification accuracy."

"Detecting malingering on the WAIS-III: Unusual digit span performance patterns in the normal population and in clinical groups" by Grant Iverson & David Tulsky. Archives of Clinical Neuropsychology, January, 2003, pages 1-9.

Summary: Documented digit span performance patters in the WAIS-III standardization group and in various clinical samples. "Base rate tables were generated for the digit span scaled score, longest span forward, longest span backward, and the vocabulary-digit span difference score. Cut-off scores for suspecting negative response bias were proposed. . ."

"Detection of Malingering Using Atypical Performance Patterns on Standard Neuropsychological Tests" by Glenn Larrabee. Clinical Neuropsychologist, August, 2003, vol. 17, #3, pages 410-425.

Summary: "Cut-off scores defining clinically atypical patterns of performance were identified for five standard neuropsychological and psychological tests: Benton Visual Form Discrimination (VFD), Fingertapping (FT), WAIS-R Reliable Digit Span (RDS), Wisconsin Card Sorting Failure-to-Maintain Set (FMS), and the Lees-Haley Fake Bad Scale (FBS) from the MMPI-2. . . . Combining the derivation and cross-validation samples yielded a sensitivity of 87.8%, specificity of 94.4%, and combined hit rate of 91.6%." In closing the discussion section, the author emphasizes that "assessment of effort in medicolegal settings must be multivariate. . . . As shown in the present investigation, requiring multiple indicators of poor effort lowers the chances of false positive identification errors in the assessment of malingering."

"Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting" by Ruocco, Anthony C.; Swirsky-Sacchetti, Thomas; Chute, Douglas L.; Mandel, Steven; Platek, Steven M.; &Zillmer, Eric A. Clinical Neuropsychologist, May, 2008, vol. 22, #3, pages 547-564.

Summary: "It is unclear whether symptom validity test (SVT) failure in neuropsychological and psychiatric domains overlaps. Records of 105 patients referred for neuropsychological evaluation, who completed the Test of Memory Malingering (TOMM), Reliable Digit Span (RDS), and Millon Clinical Multiaxial Inventory-III (MCMI-III), were examined. TOMM and RDS scores were uncorrelated with MCMI-III symptom validity indices and factor analysis revealed two distinct factors for neuropsychological and psychiatric SVTs. Only 3.5% of the sample failed SVTs in both domains, 22.6% solely failed the neuropsychological SVT, and 6.1% solely failed the psychiatric SVT. The results support a dissociation between neuropsychological malingering and exaggeration of psychiatric symptoms in a neuropsychological setting."

"Feigned intellectual deficits on the Wechsler Adult Intelligence Scale-Revised" by Lorraine Johnstrone & David Cooke. British Journal of Clinical Psychology, September, 2003, vol. 42, #3, pages 303-318.

Summary: Examined methods of faking intellectual impairment by incarcerated young offenders and students and research fellows in a university psychology department. "Both groups produced faked mean IQ scores within the 'mental retardation' range. There were, however, unusual features in the answers of both groups, including unusual error types. The faking tactics employed were readily detected. The results suggest that an individual's WAIS-R performance should be interpreted with due consideration given to both the quantitative and the qualitative aspects of their presentation."

"Intraindividual variability as an indicator of malingering in head injury" by Esther, Strauss, Daniel Slick, Judi Levy-Bencheton, Michael Hunter, Stuart MacDonald, & David Hultsch. Archives of Clinical Neuropsychology, July, 2002, pages 423-444.

Summary: Analog study of malingering using the Reliable Digit Span (RDS) task, the Victoria Symptom Validity Test (VSVT), and the Computerized Dot Counting Test (CDCT). Half the participants were asked to fake an injury convincingly and the other half were asked to take the tests honestly. Findings suggest that "regardless of an individual's experience, consideration of both level of performance (particularly on forced-choice symptom validity tasks) and intraindividual variability holds considerable promise for the detection of malingering."

"Malingering detection in a Spanish population with a known-groups design" by Vilar-López, Raquel; Gómez-Río, Manuel; Santiago-Ramajo, Sandra; Rodríguez-Fernández, Antonio; Puente, Antonio E.; & Pérez-García, Miguel. Archives of Clinical Neuropsychology, July, 2008, vol. 23, #4, pages 365-377.

Summary: "Malingering detection has become a topic of increased interest in the US over the last years. However, this development has not been matched in Europe. For example, in Spain there is insufficient evidence to support the use of reliable and valid malingering tests. In this study, we tested the applicability of two malingering detection tests (Test of Memory Malingering (TOMM) and Dot Counting Test) in a Spanish sample. The sample included three groups of patients (30 non-compensation seeking, 14 compensation seeking non-suspected of malingering, and 10 suspected of malingering) and a group of analog students (n = 54). Tests' results were able to discriminate between the groups of malingerers (both patients and analogs) and non-malingerers (both compensation seeking and non-compensation seeking). However, the TOMM achieved a higher overall classification rate than the Dot Counting Test. Our results encourage the use of the TOMM as an indicator of malingering with Spanish population."

"Malingering in Toxic Exposure: Classification Accuracy of Reliable Digit Span and WAIS-III Digit Span Scaled Scores" by Kevin Greve,, Steven Springer, Kevin Bianchini,William Black,, Matthew Heinly,, Jeffrey Love,, Douglas Swift,, & Megan Ciota. Assessment,, March, Vol 14(1), pages 12-21.

Summary: This research "examined the sensitivity and false-positive error rate of reliable digit span (RDS) and the WAIS-III Digit Span (DS) scaled score in persons alleging toxic exposure and determined whether error rates differed from published rates in traumatic brain injury (TBI) and chronic pain (CP). Data were obtained from the files of 123 persons referred for neuropsychological evaluation related to alleged exposure to environmental and industrial substances. Malingering status was determined using the criteria of Slick, Sherman, and Iverson (1999). The sensitivity and specificity of RDS and DS in toxic exposure are consistent with those observed in TBI and CP. These findings support the use of these malingering indicators in cases of alleged toxic exposure"

"Neuropsychological profiling of symptom exaggeration and malingering" by Wiley Mittenberg, Gisela Aguila-Puentes, Christine Patton, Elizabeth Canyock, & Robert Heilbronner. Journal of Forensic Neuropsychology, 2002, 3, pages 227-240.

Summary: Reviews approaches using profile analysis to identify malingered head injury on the Wechsler Adult Intelligence Scale (WAIS-III), Wechsler Memory Scale (WMS-R), and Halstead-Reitan Battery. "These techniques lend themselves to the report of specific statements about the probability of malingering that are easily understood by the court and are likely to meet current standards for evidentiary reliability."

"Use of reliable digits to detect malingering in a criminal forensic pretrial population" by Scott Duncan & Denella Ausborn. Assessment, March, 2002, 56-61.

Summary: A cross-validation study extending previous research "on the reliable digits method of detecting suspected malingering on the Wechsler Adult Intelligence Scale - Revised (WAIS-R). The results support the use of the reliable digits method on a criminal forensic pretrial population . . . . Sensitivities, specificities, and incremental hit rates for 2 cut levels of the reliable digits method, MMPI-2 Infrequency and the Personality Assessment Inventory Negative Impression Scales, as well as multiple combined cut scores, were comparable to those observed in previous studies that used neuropsychologically evaluated participants."

"Use of the Wechsler Adult Intelligence Scale Digit Span subtest for malingering detection: A meta-analytic review" by Jasinski, L. J., D. T. R. Berry, et al. Journal of Clinical and Experimental Neuropsychology, 2011, 33(3), pages 300-314.

Summary: “Twenty-four studies utilizing the Wechsler Adult Intelligence Scale (WAIS) Digit Span subtest—either the Reliable Digit Span (RDS) or Age-Corrected Scaled Score (DS-ACSS) variant—for malingering detection were meta-analytically reviewed to evaluate their effectiveness in detecting malingered neurocognitive dysfunction. RDS and DS-ACSS effectively discriminated between honest responders and dissimulators, with average weighted effect sizes of 1.34 and 1.08, respectively. No significant differences were found between RDS and DS-ACSS. Similarly, no differences were found between the Digit Span subtest from the WAIS or Wechsler Memory Scale (WMS). Strong specificity and moderate sensitivity were observed, and optimal cutting scores are recommended.”

"Utilising the WAIS-III/WMS-III in clinical practice: Update of research and issues relevant to Australian normative research" by James Holdnack, Dianne Lissner, Stephen Bowden, & Kerri McCarthy. Australian Psychologist, November 2004, vol. 39, #3, pages 220-227.

Summary: One section of this article reviews studies of malingering.

"WAIS-IV digit Span variables: Are they valuable for use in predicting TOMM and MSVT failure?" Whitney, K. A., et al. (2013). Applied Neuropsychology: Adult 20(2): 83-94.

Summary: "Findings from this retrospective analysis showed that, regardless of whether the TOMM or the MSVT was used as the negative response bias criterion, of all the DS variables examined, DS Sequencing Total showed the best classification accuracy. Yet, due to its relatively low positive and negative predictive power, DS Sequencing Total is not recommended for use in isolation to identify negative response bias."

"What Tests Are Acceptable for Use in Forensic Evaluations? A Survey of Experts" by Stephen Lally. Professional Psychology: Research & Practice, October, 2003, vol. 34, #5, pages 491-498.

Surveyed diplomates in forensic psychology "regarding both the frequency with which they use and their opinions about the acceptability of a variety of psychological tests in 6 areas of forensic practice. The 6 areas were mental state at the offense, risk for violence, risk for sexual violence, competency to stand trial, competency to waive Miranda rights, and malingering." In regard to the forensic assessment of malingering, "the majority of the respondents rated as acceptable the Structured Interview of Reported Symptoms (SIRS), Test of Memory Malingering, Validity Indicator Profile, Rey Fifteen Item Visual Memory Test, MMPI-2, PAI, WAIS-III, and Halstead-Reitan. The SIRS and the MMPI-2 were recommended by the majority. The psychologists were divided between acceptable and unacceptable about using either version of the MCMI (II or III). They were also divided, although between acceptable and no opinion, for the WASI, KBIT, Luria-Nebraska, and Stanford-Binet-Revised. The diplomates viewed as unacceptable for evaluating malingering the Rorschach, 16PF, projective drawings, sentence completion, and TAT. The majority gave no opinion on the acceptability of the Malingering Probability Scale, M-Test, Victoria Symptom Validity Test, and Portland Digit Recognition Test."

Wechsler Memory Scale

"Base rate of WMS-R Malingering Index in a sample of non-compensation-seeking men infected with HIV-1" by Daniel Slick, Charles Hinkin, Wilfred van Gorp, & Paul Satz. Applied Neuropsychology, September, 2001, pages 185-189.

Summary: The authors report that "Mittenberg et al (1993) proposed a malingering index score for the Wechsler Memory Scale-Revised that is derived by subtracting the Attention/Concentration Index (ACI) score from the General Memory Index Score (GMI). This study is a cross-validation of the specificity of the GMI-ACI Malingering Index in a sample of 55 non-compensation-seeking HIV-positive (HIV+) patients (aged 23-64 yrs). An overall false-positive rate of 7% was observed for the GMI-ACI Malingering Index. However, further analyses showed that GMI-ACI Malingering Index scores were correlated with GMI scores such that false-positive errors were substantially higher among patients who obtained above-average GMI scores. These findings suggest a cautious approach to application of the GMI-ACI Malingering Index, particularly among patients who obtain above-average GMI scores."

"Brief screening indexes for malingering: A confirmation of vocabulary minus digit span from the WAIS-III and the rarely missed index from the WMS-III" by Lori Miller, Joseph Ryan, Christine Carruthers, & Richard Cluff. Clinical Neuropsychologist, May, 2004, vol. 18, #2, pages 327-333.

Summary: In this study, the "first measure evaluated was Vocabulary (V) minus Digit Span (DS) (Mittenberg, Theroux-Fichera, Zielinski, & Heilbronner, 1995); the second measure was the Rarely Missed Index (RMI) for the WMS-III Logical Memory subtest (Killgore & Della-Pietra, 2000). V-DS misclassified 0% of individuals in the alcohol abuse group, 2% of those in the polysubstance abuse group, and 0% of head injury cases. RMI misclassification rates were 3%, 5%, and 7% for the alcohol abuse, polysubstance abuse, and head injury groups, respectively."

"Ecological validity of the WMS-III Rarely Missed Index in personal injury litigation" by Rael Lange, Karen Sullivan, and Debbie Anderson. Journal of Clinical & Experimental Neuropsychology, May, 2005, vol. 27, # 4, pages 412-424.

Summary: This study found that the "clinical utility of the RMI to identify Suspected Exaggerators versus individuals in the Genuine Responder and Mixed Clinical groups revealed low sensitivity (sensitivity = .25), very high specificity (range = .91 to .95), moderate positive predictive power (range = .50 to .71), and moderate to high negative predictive power (range = .68 to .83). These results do not support the use of the RMI as a reliable predictor of cognitive exaggeration."

"Effects of incentive and preparation time on performance and classification accuracy of standard and malingering-specific memory tests" by David Shum, John O'Gorman, & Arlene Alpar. Archives of Clinical Neuropsychology, September, 2004, vol 19, #6, pages 817-823.

Summary: This simulation study used a "2 (no incentive vs. a $20 incentive) * 2 (immediate vs. delayed preparation) factorial design. Eighty undergraduate students and 15 individuals with traumatic brain injury were administered standard (viz., Digit Span and Visual Memory Span from the WMS-R) and malingering-specific (viz., the Rey 15-Item Memory Test and the Multi-Digit Memory Test) memory tests. Preparation time was found to have a significant effect on performance and classification accuracy on a number of these tests, but incentive was found to have a significant effect on the performance but not the classification accuracy of one test (viz., the Multi-Digit Memory Test). These findings suggest that extra-test variables such as incentive and preparation time should be taken into consideration in evaluating the utility of standard and malingering-specific memory tests in detecting malingering."

"Neuropsychological profiling of symptom exaggeration and malingering" by Wiley Mittenberg, Gisela Aguila-Puentes, Christine Patton, Elizabeth Canyock, & Robert Heilbronner. Journal of Forensic Neuropsychology, 2002, 3, pages 227-240.

Summary: Reviews approaches using profile analysis to identify malingered head injury on the Wechsler Adult Intelligence Scale (WAIS-III), Wechsler Memory Scale (WMS-R), and Halstead-Reitan Battery. "These techniques lend themselves to the report of specific statements about the probability of malingering that are easily understood by the court and are likely to meet current standards for evidentiary reliability."

"Partial cross-validation of the Wechsler Memory Scale--Revised (WMS-R) General Memory--Attention/Concentration Malingering Index in a nonlitigating sample" by Robin Hilsabeck, Matthew Thompson, James Irby, Russell Adams, James Scott, & Drew Gouvier. Archives of Clinical Neuropsychology, January, 2003, pages 71-79.

Summary: Examined 200 people who were not involved in litigation. Participants included those with "traumatic brain injury (TBI), brain tumor, stroke/vascular, senile dementia of the Alzheimer's type (SDAT), epilepsy, depression/anxiety, medical problems, and no diagnosis." Among the findings were that "the discriminant function using WMS-R subtests misclassified only 6.5% of the sample as malingering, with significantly higher misclassification rates of SDAT and stroke/vascular groups. The General Memory Index-Attention/Concentration Index (GMI-ACI) difference score misclassified only 8.5% of the sample as malingering when a difference score of greater than 25 points was used as the cutoff criterion."

"Quantitative measures of memory malingering on the Wechsler Memory Scale--Third edition in mild head injury litigants" by Pauline Langeluddecke & Sara Lucas. Archives of Clinical Neuropsychology, March, 2003, 18, pages 181-197.

Summary: In comparing "25 mild traumatic brain injury (TBI) litigants who met the criteria for probable malingered neurocognitive dysfunction" with 50 "nonmalingering subjects," the study found: "malingerers showed globally depressed memory function. They returned significantly poorer scores than nonmalingerers on all WMS-III indexes and subtests, and on selected WMS-III index difference scores and intelligence-memory difference scores. Using the minimum score returned in the nonmalingerers as the cut-off for malingering, the delayed auditory recognition memory tasks were highly effective in detecting malingering."

"Suppressed working memory on the WMS-III as a marker for poor effort" by Rael Lange, Grant Iverson, Karen Sullivan, and Debbie Anerson. Journal of Clinical and Experimental Neuropsychology, in press.

Summary: This study of 145 personal injury litigants concluded that the findings "do not support the use of memory-WMI discrepancy scores on the WMS-III as a reliable predictor of poor effort."

"Using the Wechsler Memory Scale-III to detect malingering in mild traumatic brain injury" by Ord, Jonathan S.; Greve, Kevin W.; & Bianchini, Kevin J. Clinical Neuropsychologist, July, 2008, vol. 22, #4, pages 689-704.

Summary: "This study examined the classification accuracy of the WMS-III primary indices in the detection of Malingered Neurocognitive Dysfunction (MND) in Traumatic Brain Injury (TBI) using a known-groups design. Sensitivity, specificity, and positive predictive power are presented for a range of index scores comparing mild TBI non-malingering (n = 34) and mild TBI malingering (n = 31) groups. A moderate/severe TBI non-malingering (n = 28) and general clinical group (n = 93) are presented to examine specificity in these samples. In mild TBI, sensitivities for the primary indices ranged from 26% to 68% at 97% specificity. Three systems used to combine all eight index scores were also examined and all achieved at least 58% sensitivity at 97% specificity in mild TBI. Specificity was generally lower in the moderate/severe TBI and clinical comparison groups. This study indicates that the WMS-III primary indices can accurately identify malingered neurocognitive dysfunction in mild TBI when used as part of a comprehensive classification system."

"Using the WMS-III faces subtest to detect malingered memory impairment" by David Glassmire, Rex Bierley, Amy Wisniewski, Roger Greene, Jan Kennedy, & Elaine Date. Journal of Clinical & Experimental Neuropsychology, June, 2003, pages 465-481.

Summary: The authors reported that "30 nonlitigating traumatic brain injury patients and 30 control participants were administered Faces under standard administration and instructed malingering conditions. Although the two groups obtained similar scores when taking the test under standard instructions, both groups produced significantly lower performances when instructed to malinger, indicating that Faces is sensitive to malingering, but less sensitive to traumatic brain injury. The total raw score provided stronger classification accuracy than an empirically weighted combination of the five easiest items (i.e., floor effect items). A raw score cutoff of 31 yielded the maximum classification accuracy with 93.3% sensitivity and 80.0% specificity."

"Utilising the WAIS-III/WMS-III in clinical practice: Update of research and issues relevant to Australian normative research" by James Holdnack, Dianne Lissner, Stephen Bowden, & Kerri McCarthy. Australian Psychologist, November 2004, vol. 39, #3, pages 220-227.

Summary: One section of this article reviews studies of malingering.

"Validation of the Rarely Missed Index (RMI) in Detecting Memory Malingering in Mild Head Injury Litigants" by Pauline Langeluddecke & Sara Lucas. Journal of Forensic Neuropsychology, 2004, vol. 4, #1, pages 49-64.

Summary: This study of 99 mild head injury litigant referrals "provided support for the general rationale of the RMI and some of its items." However, approximately "75% of subjects were correctly classified in terms of malingering status with the RMI, which is considerably lower than in the original study. The rate of false positives was 25%..."

Wisconsin Card Sorting Test (WCST)

"Detecting malingered performance with the Wisconsin Card Sorting Test: A preliminary investigation in traumatic brain injury" by Kevin Greve, Kevin Bianchini, Charles Methias, Rebecca Houston, & John Crouch. Clinical Neuropsychologist, May, 2002, pages 179-191.

Summary: Examined malingering indicators on the Wisconsin Card Sorting Test (WCST) with 89 traumatic brain injury patients. "Individual Sensitivities were greater than .33 with acceptable Specificity. Combined Sensitivity for 2 of the indicators was greater than .60."

"Detection of Malingering Using Atypical Performance Patterns on Standard Neuropsychological Tests" by Glenn Larrabee. Clinical Neuropsychologist, August, 2003, vol. 17, #3, pages 410-425.

Summary: "Cut-off scores defining clinically atypical patterns of performance were identified for five standard neuropsychological and psychological tests: Benton Visual Form Discrimination (VFD), Fingertapping (FT), WAIS-R Reliable Digit Span (RDS), Wisconsin Card Sorting Failure-to-Maintain Set (FMS), and the Lees-Haley Fake Bad Scale (FBS) from the MMPI-2. . . . Combining the derivation and cross-validation samples yielded a sensitivity of 87.8%, specificity of 94.4%, and combined hit rate of 91.6%." In closing the discussion section, the author emphasizes that "assessment of effort in medicolegal settings must be multivariate. . . . As shown in the present investigation, requiring multiple indicators of poor effort lowers the chances of false positive identification errors in the assessment of malingering."

"Specificity of Malingering Detection Strategies in Older Adults Using the CVLT and WCST" by Lee Ashendorf, Sid O'Bryant, & Robert McCaffrey. Clinical Neuropsychologist, May, 2003, vol. 17, #2, pages 255-262.

Summary: According to the article, the studies findings suggested that "The currently existing WCST formulas may have limited utility for the detection of malingering with older adults while the CVLT strategies do appear to have potential clinical utility."

Word Completion Memory Test (WCMT)

"Detecting simulated memory impairment: Further validation of the Word Completion Memory Test (WCMT)" by Robin Hilsabeck & Drew Gouvier. Archives of Clinical Neuropsychology, December, 2005, vol. 20, #8, pages 1025-1041.

Summary: ". Seventy-one participants were recruited for this study: 30 normal volunteers and 11 memory-disordered patients instructed to perform their best, and 30 normal volunteers instructed to fake memory impairment. Normal volunteers were administered five tests of neuropsychological functioning and five tests of simulation to explore the convergent and divergent validity of the WCMT. Two weeks later, these participants completed all 10 measures a second time. Memory-disordered patients were administered the WCMT and two additional simulation measures as part of a comprehensive neuropsychological evaluation. The WCMT successfully discriminated simulators from nonsimulators with an overall classification accuracy of 97% and demonstrated good psychometric properties."

"Word Completion Memory Test (WCMT): A new test to detect malingered memory deficits" by Robin Hilsabeck, Denny LeCompte, Allison Marks, & Jordon Grafman. Archives of Clinical Neuropsychology, October, 2001, pages 669-677.

Summary: The authors report that their study "presents preliminary validation data on a new measure, the Word Completion Memory Test (WCMT), which is the first malingering test to utilize a sophisticated coaching methodology in its development. The WCMT was administered to control participants, memory-impaired patients, and coached simulators. The coached simulators were provided with specific information about and examples of memory deficits commonly experienced following closed head injury (CHI; e.g., anterograde vs retrograde amnesia). They also read a detailed scenario describing the lifestyle and motivations likely experienced by CHI litigants, and then practiced their roles by taking a quiz about their deficits. Results showed that 93% of coached simulators and 100% of control and memory-impaired participants were correctly classified by the WCMT."

Word Memory Test

"Age related effects in children taking the Computerized Assessment of Response Bias and Word Memory Test" by John Courtney, Juliet Dinkins, Lyle Allen, & Katherine Kuroski, Katherine. Child Neuropsychology. June, 2003, vol. 9, #2, pages109-116.

Summary: This study assessed the possible effects of age on childrens' performance on the Word Memory Test (WMT) and the Computerized Assessment of Response Bias (CARB). "Statistical analysis suggests that younger children (those under 10 years of age) tended to produce poorer performance on these instruments."

"Can malingering be identified with the Judgment of Line Orientation Test?" by Grant Iverson. Applied Neuropsychology, September, 2001, pages 167-173.

Summary: The author reported that, "A large sample of 294 individuals involved in head injury litigation took the JLO and 2 tests designed to detect biased responding, the Computerized Assessment of Response Bias (CARB) and the Word Memory Test (WMT), as part of a comprehensive neuropsychological evaluation. Patients were divided into groups on the basis of brain injury severity and whether or not they scored in the suspicious range on the CARB or WMT. The patients who were identified as providing biased responding on the CARB or WMT also scored significantly lower on the JLO. However, the cutoff score correctly identified only 9.9% of this group, with a 1% possible false-positive rate. A different cutoff score was selected that had .22 sensitivity and .96 specificity. Overall, these results suggest that the JLO has limited utility as a screen for biased responding; however, clinicians are encouraged to evaluate these scores carefully if they do not seem to make biological or psychometric sense."

"Comparison of WMT, CARB, and TOMM failure rates in non-head injury disability claimants" by Roger Gervais, Martin Rohling, Paul Green, and Wendy Ford. Archives of Clinical Neuropsychology, June, 2004, vol. 19, #4, pages 475-487.

Summary: This study examined 519 claimants who were referred for disability or personal injury related assessments. They "were administered three SVTs, one based on digit recognition (Computerized Assessment of Response Bias, CARB), one using pictorial stimuli (Test of Memory Malingering, TOMM) and one employing verbal recognition memory (Word Memory Test, WMT). More than twice as many people failed the WMT than TOMM. CARB failure rates were intermediate between those on the other two tests. Thus, tests of recognition memory using digits, pictorial stimuli or verbal stimuli, all of which are objectively extremely easy tasks, resulted in widely different failure rates. This suggests that, while these tests may be highly specific, they vary substantially in their sensitivity to response bias."

"Coverage of the test of memory malingering, victoria symptom validity test, and word memory test on the internet: Is test security threatened?" by Lyndsey Bauer & Robert McCaffrey. Archives of Clinical Neuropsychology, January, 2006, vol. 21, #1, pages121-126.

Summary: This study looked at "Internet coverage of SVTs because it is potentially another source of coaching, or information that is readily available. Google searches were performed on the Test of Memory Malingering, the Victoria Symptom Validity Test, and the Word Memory Test. Results indicated that there is a variable amount of information available about each test that could threaten test security and validity should inappropriately interested parties find it."

"Detecting malingering in traumatic brain injury and chronic pain: A comparison of three forced-choice symptom validity tests" by Greve, Kevin W.; Ord, Jonathan; Curtis, Kelly L.; Bianchini, Kevin J.; & Brennan, Adrianne. Clinical Neuropsychologist, August, 2008, vol. 22, #5, pages 896-918.

Summary: "Individual and joint malingering detection accuracy of the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) was examined in traumatic brain injury (TBI; 43 non-malingering, 27 malingering) and chronic pain (CP; 42 non-malingering, 58 malingering) using a known-groups design. At published cutoffs, the PDRT and TOMM were very specific but failed to detect about 50% of malingerers; the WMT was sensitive but prone to false positive errors. ROC analyses demonstrated comparable accuracy across all three tests. Joint classification accuracy was superior to that of the individual tests."

"Detecting neuropsychological malingering: Effects of coaching and information" by Thomas Dunn, Paula Shear, Steven Howe, & Douglas Ris. Archives of Clinical Neuropsychology, March, 2003, pages 121-134.

Summary: This study found: "that the CARB-97 and WMT differentiate 'normal' from 'malingered' instructional sets, and show little difference between naive and coached malingering efforts. . . . [R]esponse times, in addition to items correct, may also be effective in detecting those who are not giving their full effort."

"Effects of coaching on symptom validity testing in chronic pain patients presenting for disability assessments" by Roger Gervais, Paul Green, Lyle Allen, & Grant Iverson. Journal of Forensic Neuropsychology, vol. 2, #2, 2001, pages 1-19.

Summary: "A total of 118 chronic pain patients (mean age 47 yrs) seen for disability-related psychological evaluations were administered the Computerized Assessment of Response Bias (CARB) and the Word Memory Test (WMT). Failure rates of over 40% were observed on both tests. When subsequent patients were informed that the CARB is unaffected by pain or emotional distress, the CARB failure rate dropped to 6%. Coaching on the WMT, however, did not alter the failure rate on this test."

"Effects of injury severity and cognitive exaggeration on olfactory deficits in head injury compensation claims" by Paul Green & Grant Iverson. NeuroRehabilitation, vol. 16, #4, 2001, pages 237-243.

Summary: This study examined the "relationship between exaggeration and scores on an olfactory discrimination test in 448 patients being assessed in connection with a claim for financial benefits. Patients completed 2 tests designed to detect exaggerated cognitive deficits, the Computerized Assessment of Response Bias (CARB) and the Word Memory Test (WMT). The diagnostic groups included 322 head injury cases (average age 38.7 yrs), varying from very minor to very severe. Patients with more severe traumatic brain injuries were 10-12 times more likely to have olfactory deficits than persons with trivial to mild head injuries. In a subgroup of patients who failed either the CARB or WMT, there was no relationship between injury severity and total scores on the smell test. The dose-response relationship between brain injury severity and olfactory deficits is severely attenuated when patients who are probably exaggerating their cognitive deficits are included in the analyses. Patients with trivial to mild head injuries who demonstrated adequate effort on the CARB and WMT were no more likely to show olfactory deficits than 126 non-head-injured control Ss."

"Effort has a greater effect on test scores than severe brain injury in compensation claimants" by Paul Green, Martin Rohling, Paul Lees-Haley,& Lyle Allen. Brain Injury. December, 2001, vol. 15, #12, pages 1045-1060.

Summary: "904 consecutive patients, including 80 neurological patients (mean age 46.5 yrs) and 470 with head injuries (mean age 39.0 yrs), were given neuropsychological tests. All 43 test scores were converted to normative Z-scores and averaged, giving an Overall Test Battery Mean (OTBM). A variable measuring effort correlated 0.73 with the OTBM. The OTBM mean score was 1.20 standard deviations lower in those who failed the Word Memory Test (WMT) than in those who passed the WMT. Sub-optimal effort suppressed the OTBM 4.5 times more than did moderate-severe brain injury. When only those making a good effort were included, patients with severe brain injuries and neurological diseases scored significantly lower than groups presumed to have no neurological impairment, but these group differences were not seen when all cases were analyzed together."

"Evaluating effort with the Word Memory Test and Category Test--or not: Inconsistencies in a compensation-seeking sample" by David Williamson, Paul Green, Lyle Allen, & Martin Rohling. Journal of Forensic Neuropsychology, 2003, vol. 3, #3, pages 19-44.

Summary: This study "compared the groups identified by the Booklet Category Test (BCT) criteria published by Tenhula and Sweet (1996) and the effort-sensitive measures of the Word Memory Test (WMT; Green, Allen & Astner, 1996) in a large sample seeking compensation after suffering head injuries of varying levels of severity. Results revealed substantial differences between the groups identified by each technique as putting forth suboptirnal effort. The groups identified by the WMT scored in a manner similar to samples identified by other investigators exhibiting poor effort. In contrast, the classifications based upon the Category Test decision rules appear to be confounded by true neurocognitive impairment, particularly in individuals who have suffered more severe brain injuries. Caution is warranted in using the Category Test decision rules to identify poor effort in compensation- seeking samples."

"How'd they do it? Malingering strategies on symptom validity tests" By Jing Tan, Daniel Slick, Esther Strauss, & David Hultsch. Clinical Neuropsychologist, December, 2002, vol. 16, #4, pages 495-505.

Summary: "Twenty-five undergraduate students were instructed to feign believable impairment following a brain injury from a car accident and 27 students were told to perform like they had recovered from such an injury on 3 "forced-choice tests, the Test of Memory Malingering (TOMM), Victoria Symptom Validity Test (VSVT), and Word Memory Test (WMT).... Test-taking strategies were evaluated by means of a questionnaire given at the end of the test session. The results revealed that all the tasks differentiated between groups. Using conventional cut-scores, the WMT proved most efficient while the VSVT captured the most participants in the definitive below-chance category. Individuals instructed to feign injury were more likely to prepare prior to the experiment, with feigning of memory loss as the most frequently reported strategy. Regardless, preparation effort did not translate into believable performance on the tests."

"Memory malingering: Evaluating WMT criteria" by Martins, M. and I. P. Martins. Applied Neuropsychology, 2010, 17(3), pages 177-182.

Summary: “The Word Memory Test (WMT) has been considered one of the best assessment tools for assessing memory malingering in spite of some reported false-positive results. Our goal was to examine the sensitivity and specificity of Green’s 2003 criteria for memory malingering using a Portuguese adaptation of the WMT. We applied the WMT to three groups of participants, including 20 healthy subjects asked to simulate memory impairment, 29 healthy adults asked to produce their best performance, and 21 patients with the diagnosis of mild cognitive impairment (MCI). Using Green’s 2003 criteria, based on scores below cutoffs on the easy subtests, 67% of the MCI patients were classified as "poor effort." However, the sensitivity and specificity of the diagnosis could be raised to 95% using an alternative set of criteria, relying on comparisons between easy and hard subtest scores. We conclude that Green’s original criteria based on easy subtest scores alone seem to be of low specificity for the diagnosis of memory impairment simulation, but the WMT is a good instrument for identifying simulation if the alternative criteria are applied.”

"Practice effect of Working Memory Test" by Xueliang Zeng, Damnin Miao, & En Huangfu. Chinese Mental Health Journal, March, 2003, vol. 17, #3, pages 164-166.

Summary: "The participants were 4 male college students (aged 19-22 yrs) at a military medical university.... . The results show that comparing the results before and after practice, there was a significant practice effect in the performances of the WMT's 2-type tests with 3 difficulty levels. The study concludes that practice effects are one of the factors affecting the results of the WMT."

"Unexamined lie is a lie worth fibbing: Neuropsychological malingering and the Word Memory Test" by David Hartman. Archives of Clinical Neuropsychology, October, 2002, pages 709-714.

Summary: Discusses administration (pencil & paper or computer) and research support for the Word Memory Test (WMT), which was developed to identify malingering.

"Word Memory Test and the validity of neuropsychological test scores" by Paul Green, Paul Lees-Haley, & Lyle Allen. Journal of Forensic Neuropsychology, 2002, vol. 2, #3-4, pages 97-124.

Summary: "Effort measured by the WMT predicted 50% of the variance in a total of 30,736 neuropsychological test results from 904 consecutive patients involved in compensation claims. In group data, WMT-measured effort was sufficient to eliminate or reverse major effects, such as the presence of greater impairment in people with severe vs mild head injuries. The removal of invalid data from people failing the WMT was found to make a major difference to the conclusions of several studies."

"Word Memory Test performance in children: by Paul Green & Loyd Flaro. Child Neuropsychology, September, 2003, vol. 9, #3, pages 189-207.

Summary: 135 children and adolescents aged 7-18 were given the Word Memory Test. The study found that "although age and verbal intelligence are known to affect scores on most ability tests, they were not found to be significant determinants of WMT effort scores. Younger children did not score any lower on the effort subtests than older children. The children scored as well as a group of parents seeking custody of their children and they scored higher than adult patients with mild head injuries. The computerized WMT requires some basic reading skills and some children with lower than a grade 3 reading level scored at a relatively low level on the effort subtests. The current data suggest that most children with at least a grade 3 reading level can pass the WMT using the adult criteria."

 

Please follow this link to go to Part 1 of the Malingering Research Update

Please follow this link to go to Part 2 of the Malingering Research Update

 

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