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.

Ability of the Wisconsin Card-Sorting Test-64 as an embedded measure to identify noncredible neurocognitive performance in mild traumatic brain injury litigants.

OBJECTIVE: To investigate the ability of selective measures on the Wisconsin Card Sorting Test-64 (WCST-64) to predict noncredible neurocognitive dysfunction in a large sample of mild traumatic brain injury (mTBI) litigants. METHOD: Participants included 114 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT). RESULTS: Participants failing PVTs performed worse across all WCST-64 dependent variables of interest compared to participants who passed PVTs. Receiver operating curve analysis revealed that only categories completed was a significant predictors of PVT status. Multivariate logistic regression did not add to classification accuracy. CONCLUSION: Consideration of noncredible executive functioning may be warranted in mild traumatic brain injury (mTBI) litigants who complete ≤ 1 category on the WCST-64.

Detection of noncredible cognitive performance with Wechsler Memory Scale-IV measures in mild traumatic brain injury litigants.

OBJECTIVE: To investigate the operating characteristics of selective measures on the Wechsler Memory Scale-IV (WMS-IV) to predict noncredible neurocognitive dysfunction in a sample of mild traumatic brain injury (mTBI) litigants. METHOD: Participants included 110 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity testing (PVT). RESULTS: Participants failing two stand-alone PVTs exhibited significantly lower scores across all WMS-IV dependent variables of interest compared to participants who passed both PVTs. Participants who failed one PVT were excluded. Bivariate logistic regression revealed that all six dependent variables were significant predictors of PVT status. The best prediction model consisted of three WMS-IV variables including Logical Memory Delayed Recall (LM2), Logical Memory Recognition (LMR), and Visual Reproduction Recognition (VRR). This model demonstrated an accuracy of 90.2%, 0.89 sensitivity, 0.92 specificity, and a Receiver Operating Curve (ROC) of 0.957. CONCLUSION: The current empirically-derived cutscores and logit equation for the WMS-IV may be an additional consideration in analyzing database validity and noncredible performance in mTBI personal injury litigants ages 18-69.

The Continuous Visual Memory Test: Update and extension on the operating characteristics as an embedded measure of cognitive performance validity.

Objective: To compare and update predictive models comprised of embedded measures from the Continuous Visual Memory Test (CVMT) in their ability to predict performance validity in personal injury litigants. Methods: Ninety-two personal injury litigants underwent a comprehensive neuropsychological examination. Criterion groups were formed, i.e. PVT-Pass and PVT-Fail, based upon their performance on stand-alone measures of performance validity (PVT). Independent-samples t-tests investigated group differences on dependent variables of interest while logistic regression analyses, as well as a decision tree classification procedure, were employed to identify the best predictive model. Results: The PVT-Fail group scored significantly lower on the 20-item Larrabee Index (LI), and three CVMT variables comprising the Henry-Enders Index (HEI) including Hits, Total Score, and Delayed Recall, but significantly higher on False Alarm Errors. Although the Total score was the best single predictor of PVT status, the addition of LI improved sensitivity. The best predictive model was derived via a classification and regression tree analysis which selected LI and CVMT-FA resulting in .91 specificity, .60 sensitivity, and ROC = 0.832. Conclusion: In the current study total CVMT scores < 70, and LI scores < 18 were rare for PI litigants with MTBI and not seen in litigants with moderate and severe brain injury who passed PVTs. Three predictive CVMT models were derived. When failure on one of the models is observed then concerns about the credibility of visual memory performance should be considered with particular attention to other stand-alone and embedded measures of performance validity.

The Pain Disability Index: Effects of performance and symptom validity in mild traumatic brain injury litigants with persistent Post-Concussion pain complaints.

OBJECTIVE: Objectives of the current study were to cross validate the Pain Disability Index (PDI) as a measure of symptom validity in a large sample of mild traumatic brain injury (MTBI) litigants with persistent post-concussive pain complaints, and investigate the effects of performance and symptom validity testing on PDI scores. METHODS: Participants included 91 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT), and the MMPI-2-RF Symptom Validity Scale (FBS-r) as a measure of symptom validity (SVT). RESULTS: Participants who failed PVT and SVT scored significantly higher on the PDI compared to participants who passed both. Failing both was associated with a large effect size. Failing PVT, but passing SVT, was associated with a medium effect on PDI scores, while passing PVT, but failing SVT demonstrated a small effect. A PDI cutscore of 49 was associated with .90 specificity and .47 sensitivity. CONCLUSION: The PDI demonstrates external validity as a self-report measure of symptom validity in MTBI litigants with persistent post-concussive pain complaints. A dose response relationship exists between PVT, SVT and PDI scores. Forensic examiners should include both PVT and SVT to optimize clinical decision making when evaluating MTBI litigants with complaints of pain-related disability years post-incident.

Response time measures on the Word Memory Test do not add incremental validity to accuracy scores in predicting noncredible neurocognitive dysfunction in mild traumatic brain injury litigants.

The objective of the current study was to investigate whether response time measures on the Word Memory Test (WMT) increase predictive validity on determining noncredible neurocognitive dysfunction in a large sample of mild traumatic brain injury (MTBI) litigants. Participants included 203 adults who underwent a comprehensive neuropsychological examination. Criterion groups were formed based upon their performance on stand-alone measures of cognitive performance validity (PVT). Participants failing PVTs exhibited significantly slower response times and lower accuracy on the WMT compared to participants who passed PVTs. Response time measures did not add significant incremental validity beyond that afforded by WMT accuracy measures alone. The best predictor of PVT status was the WMT Consistency Score (CNS) which was associated with an extremely large effect size (d = 16.44), followed by Immediate Recognition (IR: d = 10.68) and Delayed Recognition (DR: d = 10.10).

The Modified Somatic Perception Questionnaire: Operating characteristics in non-pain forensic samples.

The objective of the current archival study was to investigate the ability of the Modified Somatic Perception Questionnaire (MSPQ) to discriminate between noncredible and credible neurocognitive dysfunction in a large mixed non-pain forensic sample comprised of personal injury litigants and disability claimants. Participants included 149 adults who underwent comprehensive neuropsychological examination. Criterion groups were formed, i.e., Credible Group (CG), or Noncredible Group (NCG) based upon their performance on stand-alone performance validity tests (PVT) including the Word Memory Test (WMT), and/or Test of Memory Malingering (TOMM), and Victoria Symptom Validity Test (VSVT). After excluding examinees with evidence of somatization participants in the NCG scored significantly higher on the MSPQ compared to participants in the CG. Scores on the MSPQ were not only related to cognitive performance validity but also amplified by the co-existence of somatization. There were no significant effects of gender, age, or race on MSPQ scores. We conclude that the MSPQ demonstrates external validity as a self-report measure of symptom validity that is sensitive to somatic and autonomic complaints in non-pain forensic samples. Future research is needed to develop MSPQ cutscores with external validity pertinent to other non-pain populations.

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).

[Formula: see text]evidence of neuropsychological dysfunction in Stevens-Johnson Syndrome and toxic epidermal necrolysis: case report.

Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) is a potentially life-threatening critical illness affecting multiple organ systems including the peripheral and central nervous system. This case report involves a young man who was diagnosed with SJS/TEN at age 16 and underwent neuropsychological assessment at age 21. Results indicate a diffuse pattern of cerebral compromise and represent a decline from premorbid level of functioning. The etiology of the cognitive impairment in this patient is likely multifactorial with possible pathophysiologic mechanisms including hypoxemia, metabolic acid-base perturbations, hyperglycemia, and delirium, as well as sepsis and inflammation.

Use of the color trails test as an embedded measure of performance validity.

One hundred personal injury litigants and disability claimants referred for a forensic neuropsychological evaluation were administered both portions of the Color Trails Test (CTT) as part of a more comprehensive battery of standardized tests. Subjects who failed two or more free-standing tests of cognitive performance validity formed the Failed Performance Validity (FPV) group, while subjects who passed all free-standing performance validity measures were assigned to the Passed Performance Validity (PPV) group. A cutscore of ≥45 seconds to complete Color Trails 1 (CT1) was associated with a classification accuracy of 78%, good sensitivity (66%) and high specificity (90%), while a cutscore of ≥84 seconds to complete Color Trails 2 (CT2) was associated with a classification accuracy of 82%, good sensitivity (74%) and high specificity (90%). A CT1 cutscore of ≥58 seconds, and a CT2 cutscore ≥100 seconds was associated with 100% positive predictive power at base rates from 20 to 50%.

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.

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.

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.

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.

Probable malingering and performance on the Continuous Visual Memory Test.

A known groups design involving 54 personal injury litigants, and disability claimants was employed to investigate group differences on the Continuous Visual Memory Test (CVMT). Group status was determined by performance on symptom validity testing and application of the Slick et al., 1999 diagnostic criteria for probable Malingered Neurocognitive Dysfunction (MND). Twenty-seven subjects who met the Slick et al., 1999 criteria formed the Probable Malingering (PM) group, while 27 subjects who did not comprised the Not Malingering (NM) group. Subjects in the PM group performed significantly worse on all CVMT variables (Hits, False Alarm Errors, Total Score, and Delayed Recall) relative to subjects in the NM group. Cutscores for the CVMT variables were empirically derived via logistic regression analyses. False Alarm Errors >or= 21 Total Score < or= 72 and Delayed Recall or= 22, and Delayed Recall

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.

Probable malingering and performance on the test of variables of attention.

Fifty subjects 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. Malingering research employing a group of probable clinical malingerers has direct generalizability to real-world settings.