Illness Perceptions Predict Cognitive Performance Validity.

OBJECTIVES: The aim of this study was to investigate the relationship of psychological variables to cognitive performance validity test (PVT) results in mixed forensic and nonforensic clinical samples. METHODS: Participants included 183 adults who underwent comprehensive neuropsychological examination. Criterion groups were formed, that is, Credible Group or Noncredible Group, based upon their performance on the Word Memory Test and other stand-alone and embedded PVT measures. RESULTS: Multivariate logistic regression analysis identified three significant predictors of cognitive performance validity. These included two psychological constructs, for example, Cogniphobia (perception that cognitive effort will exacerbate neurological symptoms), and Symptom Identity (perception that current symptoms are the result of illness or injury), and one contextual factor (forensic). While there was no interaction between these factors, elevated scores were most often observed in the forensic sample, suggesting that these independently contributing intrinsic psychological factors are more likely to occur in a forensic environment. CONCLUSIONS: Illness perceptions were significant predictors of cognitive performance validity particularly when they reached very elevated levels. Extreme elevations were more common among participants in the forensic sample, and potential reasons for this pattern are explored. (JINS, 2018, 24, 735-745).

Development of the MMPI-2 cognitive complaints scale as an embedded measure of symptom validity.

OBJECTIVE: To empirically-derive a new MMPI-2 sub-scale, the 13-item Cognitive Complaints Scale (CCS), as an embedded measure of symptom validity. This study hypothesized that mild traumatic brain injured subjects with financial incentives who failed performance validity tests (PVTs) would score significantly higher on the CCS compared to mild traumatic brain injured subjects with financial incentives who passed PVTs. Mild traumatic brain injured controls with no financial incentives were predicted to score lowest on the CCS. RESEARCH DESIGN: A known groups design was utilized as this design allows for the accurate classification of criterion groups. METHODS: One hundred and fifty mild head-injured adults were assigned to one of three groups: the Failed Performance Validity (FPV) group, the Passed Performance Validity (PPV) group or a control group. RESULTS: An ANOVA revealed that the FPV group scored significantly higher on the CCS compared to the PPV group. Controls with no financial incentives scored lowest. A CCS cut-score of ≥12 discriminated between the FPV and PPV groups at a high level of specificity (94%). CONCLUSIONS: A dissociation between 'performance validity' and 'symptom validity' supports recommendations for the differential application of these descriptive terms. The CCS may be helpful to assess credibility of clinical presentation in situations where PVTs are absent.

Noncredible performance in individuals with external incentives: empirical derivation and cross-validation of the Psychosocial Distress Scale (PDS).

Using a known groups design, a new Minnesota Multiphasic Personality Inventory (MMPI-2) subscale, the 20-item Psychosocial Distress Scale (PDS), was empirically derived and cross-validated. The PDS demonstrated good classification accuracy between subjects under external incentive vs. no incentive conditions. In the initial calibration sample (N = 84) a cut score of ≥10 on the PDS was associated with good classification accuracy (85.7%), high specificity (90.0%), and adequate sensitivity (81.8%). Under cross-validation conditions (N = 83) a cut score of ≥10 on the PDS was also associated with nearly identical classification accuracy (86.5%), specificity (91.89%), and sensitivity (82.61%). A cut score of ≥12 was associated with 100% positive predictive power; that is, no false-positive errors in both the initial calibration sample and the subsequent cross-validation sample. The current study suggests that in addition to noncredible cognitive performance, civil litigants and disability claimants may overreport psychosocial complaints that can be identified and that the scale may generalize to other settings and patient groups.

The relationship of cogniphobia to performance validity and symptom validity in neuropsychological assessment.

OBJECTIVE: Emerging research suggests that fear and avoidance are associated with not only physical symptoms, but also cognitive functioning. The concept of cogniphobia describes the fear and avoidance of cognitively effortful tasks to avoid the onset or worsening of symptoms. Extant studies provide preliminary evidence for associations between cogniphobia and validity testing. However, less is known about the subcomponents of cogniphobia. This study investigated the relationship of cogniphobia subcomponents to validity testing and psychological presentations. METHOD: Participants included 171 adults from an archival database who had completed measures of cogniphobia and psychological symptom reports as part of a larger neuropsychological study. The sample was classified as scoring above or below published cutoffs on performance validity tests (PVTs) and symptom validity tests (SVTs), consistent with current research/recommendations. RESULTS: Confirmatory factor analysis (CFA) supported a two-factor model of cogniphobia, with Avoidance and Dangerousness as subcomponents. Logistic regression analyses identified Avoidance as the strongest predictor of scores falling in the invalid range on PVTs and SVTs, as well as the presence of external incentives. After excluding participants who fell in the invalid range on SVTs, only Avoidance significantly predicted report of somatic complaints. CONCLUSIONS: Cogniphobia, especially the avoidance of cognitive exertion component, is associated with performance in the invalid range on both PVTs and SVTs and is also related to report of somatic concerns when controlling for beliefs that cognitive exertion is dangerous. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: Update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering.

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term 'malingering.' Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures.

Neuropsychological and Criminological Features of Female Homicide Offenders.

Few studies have examined life history and cognitive characteristics unique to female homicide offenders. Understanding these characteristics could aid in risk assessment for extreme violence in this group of offenders. The current study utilized t-tests or chi-square tests to compare 27 female and 81 male homicide offenders on psychiatric, neurologic, criminal, and cognitive characteristics. Additionally, we explored the role of abuse history in female offenders through Kruskal-Wallis or Fisher's exact tests. Results indicate that in comparison with male counterparts, females are more likely to have history of mood disorder, borderline personality disorder, and abuse. Cognitively, female homicide offenders exhibit circumscribed cognitive impairment in verbal abilities and perform similarly to male homicide offenders across most cognitive tasks. Within the female offender group, history of sexual abuse is associated with higher rates of impulsive homicide and poorer verbal abilities. These findings provide preliminary evidence for distinct factors associated with homicide in women.

Use of MMPI-2 to predict cognitive effort: a hierarchically optimal classification tree analysis.

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context.

The relation between symptom validity testing and MMPI-2 scores as a function of forensic evaluation context.

The association between scores on MMPI-2 scales and cognitive symptom validity test (SVT) failure was investigated in 127 criminal defendants evaluated for competency to stand trial, criminal responsibility, and drug dependence, and 141 personal injury and disability claimants. Results indicated that SVT failure was associated with exaggerated symptom presentation involving somatic complaints in civil litigants and more global exaggeration of psychopathology and somatic complaints in criminal defendants. Scores on the MMPI-2 Fake Bad Scale (FBS) were associated with SVT failure in both civil and criminal litigants, whereas scores on the MMPI-2 F(P) scale were associated with SVT failure in criminal defendants, but not in civil plaintiffs. These results support the utility of the FBS as an indicator of non-credible presentation of somatic and cognitive complaints in both civil and criminal forensic psychological assessments, and indicate that the lack of association between the MMPI-2 infrequency scales and SVT failure is limited to civil forensic settings.

Derivation of the MMPI-2-RF Henry-Heilbronner Index-r (HHI-r) scale.

The 15-item Henry-Heilbronner Index (HHI) was published in 2006 as an MMPI-2 embedded measure of psychological response validity. When the MMPI-2 was revised in 2008 only 11 of the 15 original HHI items were retained on the MMPI-2-RF, prohibiting use of the HHI as an embedded validity indicator on the MMPI-2-RF. Using the original HHI sample an 11-item version of the HHI, the HHI-r, was evaluated for use as an embedded measure of psychological response validity for the MMPI-2-RF. The 11-item HHI-r was very similar to the HHI in classification accuracy. An HHI-r cutoff score of ≥7 was associated with a classification accuracy rate of 84.0%, good sensitivity (68.9%), and high specificity (93.2%) in identifying symptom exaggeration in personal injury and disability litigants versus non-litigating head-injured patients. These preliminary results suggest the HHI-r functions in a manner similar to the original HHI as a measure of psychological response validity, and may be used by psychologists and neuropsychologists as an MMPI-2-RF embedded validity indicator.

Official position of the American Academy of Clinical Neuropsychology on serial neuropsychological assessments: the utility and challenges of repeat test administrations in clinical and forensic contexts.

Serial assessments are now common in neuropsychological practice, and have a recognized value in numerous clinical and forensic settings. These assessments can aid in differential diagnosis, tracking neuropsychological strengths and weaknesses over time, and managing various neurologic and psychiatric conditions. This document provides a discussion of the benefits and challenges of serial neuropsychological testing in the context of clinical and forensic assessments. Recommendations regarding the use of repeated testing in neuropsychological practice are provided.

Further validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: findings from disability and criminal forensic settings.

The present study extends the validation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Response Bias Scale (RBS; R. O. Gervais, Y. S. Ben-Porath, D. B. Wygant, & P. Green, 2007) in separate forensic samples composed of disability claimants and criminal defendants. Using cognitive symptom validity tests as response bias indicators, the RBS exhibited large effect sizes (Cohen's ds = 1.24 and 1.48) in detecting cognitive response bias in the disability and criminal forensic samples, respectively. The scale also added incremental prediction to the traditional MMPI-2 and the MMPI-2-RF overreporting validity scales in the disability sample and exhibited excellent specificity with acceptable sensitivity at cutoffs ranging from 90T to 120T. The results of this study indicate that the RBS can add uniquely to the existing MMPI-2 and MMPI-2-RF validity scales in detecting symptom exaggeration associated with cognitive response bias.

Comparison of the MMPI-2 restructured Demoralization Scale, Depression Scale, and Malingered Mood Disorder Scale in identifying non-credible symptom reporting in personal injury litigants and disability claimants.

A known groups design compared the ability of the 24-item MMPI-2 Restructured Clinical Demoralization Scale (RCd), the 57-item Depression Scale (Scale 2), and the 15-item Malingered Mood Disorder Scale (MMDS) to identify non-credible symptom response sets in 84 personal injury litigants and disability claimants compared to 77 non-litigating head-injured controls. All three scales showed large effect sizes (>0.80). Scale 2 was associated with the largest effect size (2.19), followed by the MMDS (1.65), and the RCd (0.85). Logistic regression analyses revealed that a cutscore of > or =28 on the 57-item Scale 2 was associated with high specificity (96.1%) and sensitivity (76.2%), while a cutscore of > or =16 on the 24-item RCd was less accurate (87% specificity and 50% sensitivity). Cutscores for the MMDS were not calculated as they were reported in a previous study. Results indicated that like the 15-item MMDS, the 57-item MMPI-2 Scale 2 may provide another empirically derived index with known error rates upon which examiners may rely to investigate hypotheses relative to exaggeration of illness-related behavior and impression management in forensic contexts involving PI litigants and disability claimants.

American Academy of Clinical Neuropsychology Consensus Conference Statement on the neuropsychological assessment of effort, response bias, and malingering.

During the past two decades clinical and research efforts have led to increasingly sophisticated and effective methods and instruments designed to detect exaggeration or fabrication of neuropsychological dysfunction, as well as somatic and psychological symptom complaints. A vast literature based on relevant research has emerged and substantial portions of professional meetings attended by clinical neuropsychologists have addressed topics related to malingering (Sweet, King, Malina, Bergman, & Simmons, 2002). Yet, despite these extensive activities, understanding the need for methods of detecting problematic effort and response bias and addressing the presence or absence of malingering has proven challenging for practitioners. A consensus conference, comprised of national and international experts in clinical neuropsychology, was held at the 2008 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN) for the purposes of refinement of critical issues in this area. This consensus statement documents the current state of knowledge and recommendations of expert clinical neuropsychologists and is intended to assist clinicians and researchers with regard to the neuropsychological assessment of effort, response bias, and malingering.

Examination of the MMPI-2 restructured form (MMPI-2-RF) validity scales in civil forensic settings: findings from simulation and known group samples.

The current study examined the effectiveness of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath and Tellegen, 2008) over-reporting indicators in civil forensic settings. The MMPI-2-RF includes three revised MMPI-2 over-reporting validity scales and a new scale to detect over-reported somatic complaints. Participants dissimulated medical and neuropsychological complaints in two simulation samples, and a known-groups sample used symptom validity tests as a response bias criterion. Results indicated large effect sizes for the MMPI-2-RF validity scales, including a Cohen's d of .90 for Fs in a head injury simulation sample, 2.31 for FBS-r, 2.01 for F-r, and 1.97 for Fs in a medical simulation sample, and 1.45 for FBS-r and 1.30 for F-r in identifying poor effort on SVTs. Classification results indicated good sensitivity and specificity for the scales across the samples. This study indicates that the MMPI-2-RF over-reporting validity scales are effective at detecting symptom over-reporting in civil forensic settings.

Neuropsychological consequences of boxing and recommendations to improve safety: a National Academy of Neuropsychology education paper.

Boxing has held appeal for many athletes and audiences for centuries, and injuries have been part of boxing since its inception. Although permanent and irreversible neurologic dysfunction does not occur in the majority of participants, an association has been reported between the number of bouts fought and the development of neurologic, psychiatric, or histopathological signs and symptoms of encephalopathy in boxers. The purpose of this paper is to (i) provide clinical neuropsychologists, other health-care professionals, and the general public with information about the potential neuropsychological consequences of boxing, and (ii) provide recommendations to improve safety standards for those who participate in the sport.

Comparison of the Lees-Haley Fake Bad Scale, Henry-Heilbronner Index, and restructured clinical scale 1 in identifying noncredible symptom reporting.

A known groups design investigated the comparative predictive validity of the 27-item MMPI-2 Restructured Scale 1 (RC1), the 43-item Lees-Haley Fake Bad Scale (FBS), and the 15-item Henry-Heilbronner Index (HHI) to identify noncredible symptom response sets in 63 personal injury litigants and disability claimants compared to 77 non-litigating head-injured controls. Logistic regression analyses revealed that the HHI and FBS were better predictors of group membership than the RC1. Results suggest that the FBS, HHI, and RC1 may be measuring different constructs. The HHI and FBS reflect an exaggeration of disability or illness-related behavior. Differences in scale construction are discussed. The RC1 may have greater relevance under external incentive conditions involving chronic pain patients, or clinical patients with no external incentive to exaggerate their symptom presentation.

Empirical derivation of a new MMPI-2 scale for identifying probable malingering in personal injury litigants and disability claimants: the 15-item Malingered Mood Disorder Scale (MMDS).

A new 15-item MMPI-2 subscale, the Malingered Mood Disorder Scale (MMDS), was empirically derived from the original 32-item Malingered Depression Scale (MDS) of Steffan, Clopton, and Morgan (2003). The MMDS was superior to the original MDS in identification of symptom exaggeration in personal injury litigants and disability claimants compared to non-litigating head-injured controls. Logistic regression revealed that a cut score of > or = 7 on the MMDS produced good specificity (93.4%) with an associated sensitivity of 54.8%. An MMDS score of > or = 8 was associated with 100% positive predictive power, i.e., no false positive errors. These results suggest that the MMDS may be useful in identifying personal injury litigants and disability claimants who exaggerate emotional disturbance on the MMPI-2.

Examination of the new MMPI-2 Response Bias Scale (Gervais): relationship with MMPI-2 validity scales.

Validity scales were recently developed to improve assessment of symptom validity beyond original MMPI-2 validity scales. In an initial study, the Response Bias Scale (RBS; Gervais, 2005) was developed based upon non-head-injury claimant performances on a cognitive effort measure, the Word Memory Test (WMT). The present study examined relationships of the RBS with numerous MMPI-2 validity scales in a sample of 211 participants with secondary gain (SG) or no secondary gain (NSG). Of the validity scales observed, RBS yielded the largest effect size difference between groups (d = .65), followed closely by FBS (d = .60) and the L-scale (d = .51). Overall, RBS correlated most significantly (r = .74, p < .001) with FBS, but also showed significant correlations with most other validity scales for both groups. RBS further demonstrated significant correlations (p < .001) with all clinical scales except for Mf. Findings suggest that RBS and FBS may represent a similar construct of symptom validity, and may outperform other MMPI-2 validity scales in discriminating SG and NSG groups. Findings provide preliminary support for use of RBS within the forensic context.

The Henry-Heilbronner Index: a 15-item empirically derived MMPI-2 subscale for identifying probable malingering in personal injury litigants and disability claimants.

A new 15-item MMPI-2 subscale, the Henry-Heilbronner Index (HHI), representing a "pseudosomatic factor," was empirically derived from both the 43-item Lees-Haley Fake Bad Scale (FBS) and the 17-item Shaw and Matthews' Pseudoneurologic Scale (PNS). The HHI was superior to both the FBS and PNS in identification of symptom exaggeration in personal injury litigants and disability claimants compared to non-litigating head-injured controls. Logistic regression analyses revealed that a cutscore of > or = 8 on the HHI was associated with good specificity (89%) and sensitivity (80%). These results suggest that the HHI may be useful in identifying personal injury litigants and disability claimants who exaggerate, overreport, or malinger physical symptoms on the MMPI-2 related to their current health and/or litigation status.