False positive diagnosis of malingering due to the use of multiple effort tests.

OBJECTIVE: Effort indicators are used to determine if neuropsychological test results are valid measures of a patient's cognitive abilities. The use of multiple effort measures is often advocated, but the false positive rate for multiple indicators depends on the number of measures used and the correlation among indicators. This study presents a meta-analysis of correlations among effort measures. False positive rates for multiple correlated indicators are then estimated using Monte Carlo simulations. METHODS: a literature search of published studies identified 22 independent samples in which 407 correlations among 31 effort measures were available in 3564 participants with normal effort. Participants were patients with neurological or psychiatric disorders and healthy volunteers. RESULTS: Meta-analysis showed a mean correlation among effort indicators of 0.31. Monte Carlo simulation based on a 15% false positive rate for individual indicators showed that, when 10 effort indicators are used together, 38% of patients with valid performance will be incorrectly identified as malingering if two failures is the diagnostic standard. Failure on five of 10 measures is required for a false positive rate of 10% or less. If five effort indicators are interpreted, a false positive rate of 19% results when two test failures are assumed to characterize poor effort and failure on three measures is required to maintain 90% specificity. CONCLUSIONS: False positive rates for effort tests increase significantly as the number of indicators that are administered is increased.

Attitudes toward psychological telehealth: current and future clinical psychologists' opinions of internet-based interventions.

OBJECTIVES: The current study explored differences in acceptance of telehealth interventions amongst currently licensed and future clinicians with a focus on web camera-based intervention. The influence of theoretical orientation was also assessed. METHOD: An online survey assessed 717 participants comprising 409 licensed psychologists (40.8% female, mean age = 56.57, standard deviation [SD] = 11.01) and 308 doctoral-level students (78.9% female, mean age = 27.66, SD = 5.9) across domains of endorsement and rejection. RESULTS: Binary logistic regression indicated no significant difference between currently licensed and future psychologists in their endorsement of telehealth modalities. Cognitive-behavioral, cognitive, behavioral, and systems psychologists were significantly more accepting of telehealth interventions than were dynamic/analytic or existential therapists. CONCLUSIONS: Increasing exposure to telehealth through education as well as continued research on efficacy for specific diagnoses may help psychologists to more effectively determine whether telehealth is the "best fit" for both clinician and client.

[Formula: see text]Expert beliefs and practices regarding neuropsychological validity testing.

OBJECTIVE: The current study investigated expert beliefs and practices as they relate to neuropsychological validity testing. METHODS: North American neuropsychologists with expertise in neuropsychological validity testing (n = 24) were surveyed on numerous items related to validity testing. Results were analyzed and compared to findings from a prior expert survey and a recent survey of a general sample of neuropsychological practitioners. RESULTS: Responses varied among experts on some items, indicating that experts have differences of opinion and practice regarding certain validity testing topics. However, expert opinion converged on a number of topics central to validity testing, particularly those highlighting the need for and importance of validity testing in neuropsychological assessment. Notably, expert responses on these topics often agreed with responses obtained from a prior expert sample and a general sample of neuropsychological practitioners. CONCLUSIONS: The results allow practitioners to see the range of validity testing beliefs and practices among current experts. Especially in those areas where consensus emerged, the results provide a way for practitioners to determine if their practices are consistent with those of their expert colleagues.

[Formula: see text]Neuropsychologists' Validity Testing Beliefs and Practices: A Survey of North American Professionals.

OBJECTIVE: The current study investigated changes in neuropsychologists' validity testing beliefs and practices since publication of the last North American survey targeting these issues in 2007 and explored emerging issues in validity testing that had not been previously addressed in the professional survey literature. METHODS: Licensed North American neuropsychologists (n = 316), who primarily evaluate adults, were surveyed in regard to the following topics: (1) comparison of objective validity testing, qualitative data, and clinical judgment; (2) approaches to validity test administration; (3) formal communication in cases of suspected malingering; (4) reporting of validity test results; (5) suspected causes of invalidity; (6) integration of stand-alone, embedded, and symptom-report validity measures; (7) multiple performance validity test interpretation; (8) research practices; and (9) popularity of specific validity instruments. RESULTS: Overall, findings from the current survey indicated that all but a small minority of respondents routinely utilize validity testing in their examinations. Furthermore, nearly all neuropsychologists surveyed believed formal validity testing to be mandatory in forensic evaluations and at least desirable in clinical evaluations. While results indicated general agreement among neuropsychologists across many aspects of validity testing, responses regarding some facets of validity test implementation, interpretation, and reporting were more variable. Validity testing utilization generally did not differ according to level of forensic involvement but did vary in respect to respondent literature consumption. CONCLUSIONS: Study findings differ significantly from past professional surveys and indicate an increased utilization of validity testing, suggesting a pronounced paradigm shift in neuropsychology validity testing beliefs and practices.

Reaffirming normal: the high risk of pathologizing healthy adults when interpreting the MMPI-2-RF.

Monte Carlo simulations were utilized to determine the proportion of the normal population expected to have scale elevations on the MMPI-2-RF when multiple scores are interpreted. Results showed that when all 40 MMPI-2-RF scales are simultaneously considered, approximately 70% of normal adults are likely to have at least one scale elevation at or above 65 T, and as many as 20% will have five or more elevated scales. When the Restructured Clinical (RC) Scales are under consideration, 34% of normal adults have at least one elevated score. Interpretation of the Specific Problem Scales and Personality Psychopathology Five Scales--Revised also yielded higher than expected rates of significant scores, with as many as one in four normal adults possibly being miscategorized as having features of a personality disorder by the latter scales. These findings are consistent with the growing literature on rates of apparently abnormal scores in the normal population due to multiple score interpretation. Findings are discussed in relation to clinical assessment, as well as in response to recent work suggesting that the MMPI-2-RF's multiscale composition does not contribute to high rates of elevated scores.

MMPI-2 Symptom Validity (FBS) Scale: psychometric characteristics and limitations in a Veterans Affairs neuropsychological setting.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity (Fake Bad Scale [FBS]) Scale is widely used to assist in determining noncredible symptom reporting, despite a paucity of detailed research regarding its itemmetric characteristics. Originally designed for use in civil litigation, the FBS is often used in a variety of clinical settings. The present study explored its fundamental psychometric characteristics in a sample of 303 patients who were consecutively referred for a comprehensive examination in a Veterans Affairs (VA) neuropsychology clinic. FBS internal consistency (reliability) was .77. Its underlying factor structure consisted of three unitary dimensions (Tiredness/Distractibility, Stomach/Head Discomfort, and Claimed Virtue of Self/Others) accounting for 28.5% of the total variance. The FBS's internal structure showed factoral discordance, as Claimed Virtue was negatively related to most of the FBS and to its somatic complaint components. Scores on this 12-item FBS component reflected a denial of socially undesirable attitudes and behaviors (Antisocial Practices Scale) that is commonly expressed by the 1,138 males in the MMPI-2 normative sample. These 12 items significantly reduced FBS reliability, introducing systematic error variance. In this VA neuropsychological referral setting, scores on the FBS have ambiguous meaning because of its structural discordance.

Minnesota Multiphasic Personality Inventory-2 revised form Symptom Validity Scale-Revised (MMPI-2-RF FBS-r; also known as Fake Bad Scale): psychometric characteristics in a nonlitigation neuropsychological setting.

This study examined fundamental psychometric characteristics of the Symptom Validity Scale-Revised (FBS-r) in a nonforensic sample of 303 neuropsychological referrals. FBS-r had a reliability (internal consistency) of .747 and two higher order factoral dimensions (Somatic Complaints and Optimism/Virtue). FBS-r had a discordant factor structure: Optimism/Virtue (7 items) was negatively related to Somatic Complaints (21 items) and undercut FBS-r measurement consistency (reliability). FBS-r scores, which purportedly reflect symptom exaggeration, are affected by as much as 23 T-score points on test items that are negatively related to symptom reporting. These data suggest that the FBS-r produces ambiguous scores reflecting two underlying dimensions that warrant additional research.

Selection criteria for internships in clinical neuropsychology.

Criteria used in the evaluation and selection of applicants for clinical neuropsychology internships were identified by a survey of programs that met guidelines for specialty training. The number of internships that offer training with specialization in clinical neuropsychology has more than doubled during the past 10 years. Supervising neuropsychologists from 75 programs replied to the survey, yielding a 72.8% response rate. Clinical experience in neuropsychological assessment, specialization in clinical neuropsychology during graduate education, personal interview, and letters of recommendation were reported to be the most salient selection criteria. Practica that provide experience with flexible or functional systems assessment approaches at university-affiliated or VA (U.S. Department of Veterans Affairs) medical centers and doctoral curricula that follow International Neuropsychological Society/Division 40 course guidelines, with teaching and supervision provided by neuropsychologists, were preferred prerequisites to internship. These results are consistent with selection criteria reported over a decade ago and indicate continued endorsement of the vertically integrated model of education and training outlined by the Houston Conference on Specialty Education and Training in Clinical Neuropsychology.

Rates of apparently abnormal MMPI-2 profiles in the normal population.

MMPI-2 standardization data were re-sampled using Monte Carlo simulations to estimate the base rate of apparently abnormal scores expected by chance in the normal population when multiple scales are interpreted. 36.8% of normal adults are likely to obtain a score that would otherwise be considered clinically significant at 65T on one or more of the 10 Clinical scales. The normal incidence of at least one apparently abnormal score was 38.3% on the Content and 55.1% on the Supplementary scales. When the Clinical, Supplementary, and Content scales and subscales are interpreted together, at least three seemingly meaningful scores will be found in 47.4% of perfectly normal individuals, and five or more scales that appear to be clinically significant can be expected in 30.1% of cases that are actually unremarkable. These results imply that the number of MMPI-2 scales that can be meaningfully interpreted in clinical practice is limited, and that high T-scores are necessary for an adequate level of confidence even when interpretation is appropriately limited to the Clinical scales.