Deception is different: Negative validity test findings do not provide "evidence" for "good effort".

Objective: The purpose of this paper is to determine whether negative validity test findings should be used in the Bayesian aggregate along with positive test findings for the determination of malingering as the condition of interest (COI). Method: Evidence-based diagnostic methods for conditions in neuropsychology and medicine were reviewed for comparison with their use in cases of malingering. Logical and Bayesian analyses of these cases were applied. A case study showed that negative validity test findings did not indicate "good effort". Results: Deception about illness is fundamentally different from other constructs/diseases in evidence-based medicine and neuropsychology. This is because deception involves a deliberate process that may involve coaching, claimant research, and/or focusing the deception on one aspect (e.g., slowness) as opposed to other neurocognitive problems (e.g., memory). Comparatively, other conditions in medicine and neuropsychology are unlikely to be manipulated by the patient. Conclusions: The assertion by Frederick (2015) and Black, Necrason, and Omasta (2016) that both positive and negative validity test findings must be used together in the aggregate does not stand up to this comparative scrutiny. The fundamental assumption by these authors that a negative test finding concerning malingering represents "good effort" is flawed; it simply represents lack of evidence of malingering, which cannot be construed as evidence of lack of malingering. We recommend that in forensic determination of malingering, negative validity test findings should not be used in a Bayesian aggregation. This conclusion is consistent with current practices in the field.

The other face of illness-deception: Diagnostic criteria for factitious disorder with proposed standards for clinical practice and research.

Objective: This paper aims to develop diagnostic criteria for factitious disorder (FD) and a heuristic for research by creating standards for delineating criterion groups.Method: Both FD and malingering are conceptualized within a rubric of illness-deception. The history of FD research was compared to the research history on malingering. Differences in the measurement of these constructs were described. The potential utility of performance validity tests (PVTs) and symptom validity tests (SVTs) in FD is discussed in light of successful applications in malingering. Methods for obtaining evidence for FD are delineated in a table of diagnostic criteria.Results: The comparison of FD and malingering research shows that the scientific measurement of malingering evolved rapidly with the introduction of forced-choice validity testing and cogent guidelines for the formation of criterion groups. Likewise, PVTs and SVTs hold promise as methods of measuring deceptive behavior in FD. The most salient differences between FD and malingering are understood to be matter of context/setting: malingering occurs in an external incentive context, while FD occurs in a medical/psychological context. Guidelines to assess FD are developed to fill the need for known-groups research.Conclusions: Evidence for FD, a form of illness-deception, can be obtained by using validity testing, which, together with careful clinical observation, allows for the development of probabilistic diagnostic criteria. Similar to the other form of illness-deception - malingering - these criteria can be used to form known groups for research.

[Formula: see text]Determination of the smoking gun of intent: significance testing of forced choice results in social security claimants.

OBJECTIVE: Significantly below-chance findings on forced choice tests have been described as revealing "the smoking gun of intent" that proved malingering. The issues of probability levels, one-tailed vs. two-tailed tests, and the combining of PVT scores on significantly below-chance findings were addressed in a previous study, with a recommendation of a probability level of .20 to test the significance of below-chance results. The purpose of the present study was to determine the rate of below-chance findings in a Social Security Disability claimant sample using the previous recommendations. METHOD: We compared the frequency of below-chance results on forced choice performance validity tests (PVTs) at two levels of significance, .05 and .20, and when using significance testing on individual subtests of the PVTs compared with total scores in claimants for Social Security Disability in order to determine the rate of the expected increase. RESULTS: The frequency of significant results increased with the higher level of significance for each subtest of the PVT and when combining individual test sections to increase the number of test items, with up to 20% of claimants showing significantly below-chance results at the higher p-value. CONCLUSIONS: These findings are discussed in light of Social Security Administration policy, showing an impact on policy issues concerning child abuse and neglect, and the importance of using these techniques in evaluations for Social Security Disability.

Malingering-by-proxy: need for child protection and guidance for reporting.

The feigning of disabling illness for compensation at the direction or pressure by others, which is called malingering by proxy (MBP), has been the subject of several spirited articles. Chafetz and Prentkowski (2011) suggested that MBP has the potential for real harm to the child. In a poster at the AACN scientific session in 2011, Chafetz and Binder (2011) pursued a case of MBP that showed the child had clearly suffered and failed to progress in the 6 years that had passed since she was first evaluated as an 11 year old. In the present article, we identify three cases that compare and contrast effects of MBP, illustrating that child abuse and/or neglect can be a serious and reportable consequence of MBP behavior. To illustrate how MBP behavior can cause child abuse, we compare MBP behavior with Munchausen Syndrome by Proxy (MSBP), another condition of volitional noncredible behavior produced in a vulnerable person at the direction or pressure by others. Guidance criteria for reporting MBP as child abuse/neglect are introduced in this article.

Estimated costs of malingered disability.

The feigning of disabling illness for the purpose of disability compensation, or "malingering," is common in Social Security Disability examinations, occurring in 45.8%-59.7% of adult cases. In this study, we estimated the costs of malingering based on mental disorder data published by the Social Security Administration. At the most widely accepted base rate of malingering in medicolegal cases involving external incentive, costs were high, totaling $20.02 billion in 2011 for adult mental disorder claimants. Moreover, these figures clearly underestimate the costs of the larger problem with feigned disability in both adults and children. We urge a change in Social Security policies to allow the use of validity testing in the examination for disability claims.

Feigning a severe impairment profile.

The main goal of a severe impairment profile (SIP) on a performance validity test (PVT) is to help reduce the false-positive rate when identifying non-credible effort in people who are truly impaired. A secondary goal is to help with clinical judgment about impairment itself. Although there is adequate specificity for the SIP in severely impaired individuals, a large proportion of simulators can produce an SIP. Given that Social Security Disability (SSD) claimants are typically low functioning and also seeking compensation, it was of interest to know whether the SIP can be used to exclude truly low-functioning claimants, or whether SSD claimants identified as malingering also produce the SIP, as the simulators in a recent study of this profile. By comparing the SSD claimants to a group of low-functioning Child Protection (CP) claimants who were motivated to do well in order to get their children returned from State custody, the findings clearly show that the SIP is easily produced in criterion-malingerers, but not in those low-functioning CP claimants motivated to do well.

Validity issues in Atkins death cases.

Justice Scalia warned in his dissent in ATKINS v. VIRGINIA, 536 U.S. 304, 122S.Ct. 2242 (2002) that the problem of feigned mental retardation would complicate the findings in cases involving the death penalty in low IQ individuals. Validity measurement in low IQ individuals has been criticized, largely with questions concerning specificity of performance validity tests (PVTs; Salekin & Doane, 2009, Applied Neuropsychology, 16, 105). In this article, our purpose is to examine the false positive rates of specific PVTs in low IQ individuals, particularly with reference to a Symptom Validity Scale previously developed for low functioning individuals (Chafetz, Abrahams, & Kohlmaier, 2007, Archives of Clinical Neuropsychology, 22, 1). The findings show that the PVTs analyzed have few false positives in a low IQ range of 60-75 when these individuals are well motivated to perform highly on testing, which allows these PVTs to be used in high stakes cases to provide evidence concerning malingering. Principles of dealing with performance validity in low functioning individuals are discussed with reference to the issues in capital cases. A practical summary guide is supplied.

The A-Test: a symptom validity indicator embedded within a mental status examination for Social Security Disability.

During the Psychological Consultative Examination (PCE) for Social Security Disability evaluations, there is a need for symptom validity measures to validate the findings for claims of disability (Chafetz, 2010 ). The "A" Random Letter Test of Auditory Vigilance (A-Test) is a simple auditory continuous performance test utilized as part of a comprehensive mental status examination (Strub & Black, 1993 ). The present study validates the use of the A-Test as a symptom validity measure easily administered as part of the PCE for Social Security Disability evaluations. This study shows that the A-Test is well correlated with other symptom validity measures, discriminates multiple symptom validity failure from nonmultiple failure, and has good classification accuracy statistics in two different studies of these claimants. The A-Test can thus easily be used as a symptom validity measure in professional psychological examinations of Social Security claimants without additional cost or much added time to the evaluation.

Reducing the probability of false positives in malingering detection of Social Security disability claimants.

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). Thus, in a typical PCE when an examiner might have only a few embedded indicators, more confidence in a diagnosis of malingering might be obtained with a finding of multiple failures.

A case of malingering by proxy in a Social Security disability psychological consultative examination.

The term "malingered neurocognitive dysfunction by proxy" was discussed by Slick, Sherman, and Iverson (1999) as part of the differential for defining malingering when a patient is responding to directions or pressure from others. In Chafetz (2008), rates of symptom validity failure in children whose parents are seeking Social Security Disability (SSD) on their behalf were presented and showed 20% to 26% symptom validity test failure rates at chance or below-chance levels. The objective of the current case study was to determine whether the requirements of malingering were met in a 9-year-old whose parent was seeking SSD on his behalf. A retrospective approach was employed using an archived case from one of the author's records. This case shows a practical application of a symptom validity scale for low-functioning individuals (Chafetz, Abrahams, & Kohlmaier, 2007), which was designed initially for use with adult and child SSD claimants. The egregious nature of symptom validity failure, coupled with SSD seeking for the whole family, along with conduct disorder symptoms provided a strong suggestion of malingering by proxy. The present results are discussed with respect to low-functioning claimants.

To work or not to work: motivation (not low IQ) determines symptom validity test findings.

Social Security Disability Determinations Service (DDS) claimants are seeking compensation for an inability to work (Chafetz, 2010). These usually low-functioning claimants fail Symptom Validity Tests (SVTs) at high rates (Chafetz, 2008), typically over 40%. In contrast, claimants for the Rehabilitation Service in Louisiana (LRS) are seeking to work. Individuals referred by the Department of Child and Family Services (DCFS) are seeking reunification with their children. All three groups consisted of equivalently low-IQ claimants when considering only those who passed SVTs. Only the DDS group failed SVTs at high rates, whereas LRS claimants failed at minimal rates and DCFS claimants did not fail. Thus, intrinsic motivation explains effort in this particular study of low-functioning claimants: those seeking to work or to look good to reunify with their children pass SVTs at high rates.

Symptom validity issues in the psychological consultative examination for social security disability.

This article is about Social Security Administration (SSA) policy with regard to the Psychological Consultative Examination (PCE) for Social Security Disability, particularly with respect to validation of the responses and findings. First, the nature of the consultation and the importance of understanding the boundaries and ethics of the psychologist's role are described. Issues particular to working with low-functioning claimants usually form a large part of these examinations. The psychologist must understand various forms of non-credible behavior during the PCE, and how malingering might be considered among other non-credible presentations. Issues pertaining to symptom validity testing in low-functioning claimants are further explored. SSA policy with respect to symptom validity testing is carefully examined, with an attempt to answer specific concerns and show how psychological science can be of assistance, particularly with evidence-based practice. Additionally, the nature and importance of techniques to avoid the mislabeling of claimants as malingerers are examined. SSA requires the use of accepted diagnostic techniques with which to establish impairment, and this article describes the implementation of that requirement, particularly with respect to validating the findings.

Malingering on the social security disability consultative exam: predictors and base rates.

The Disability Determinations Service (DDS) obtains evidence about an applicant from sources that may include the Psychological Consultative Examination (PCE), which usually includes a mental status examination and Wechsler Scale findings. Although evidence for good effort is necessary to validate the findings, psychologists have been officially discouraged from determining effort by the use of formal tests. In Chafetz, Abrahams, and Kohlmaier (2007), indicators of effort within the PCE in WAIS-age (adults) and WISC-age (children) claimants were determined, and a PCE Malingering Rating Scale was developed. In the present study, this new scale was used along with established symptom validity tests (SVTs) to determine base rates and additional predictors of malingering within the PCE. Claimants were apportioned into separate effort groups in a "dose-response" manner: Definite Malingerers, Chance-Level, Fail Both (SVT and Rating Scale), Fail One, Fail Indicators, and Not Fail. Data from separate studies using the Test of Memory Malingering (TOMM), and the Medical Symptom Validity Test (MSVT) were used to assign claimants into separate effort groups. An evidence-based assessment approach utilized these base-rates to calculate post-test odds. Other predictors of effort within the PCE include the presence of conduct disorder symptoms, and the number of other family members on Disability.

Malingering on the Social Security disability consultative exam: a new rating scale.

In disability examinations, benefits may depend on the findings of a psychological consultative examination (PCE), which in Louisiana usually involves a mental status examination and a Wechsler Scale. The disability determinations service (DDS) requires a warning that failure to do one's best may result in an unfavorable decision on the claim, but psychologists are officially discouraged from determining effort by the use of formal effort tests. Consequently, there is a need for internal indicators of effort. Formal testing of effort was undertaken in order to identify indicators of effort within the PCE in WAIS-age and WISC-age claimants. Our findings indicated that the total score of indicators was more predictive of effort than any single indicator. Regression equations yielded information on how much effort contributes to IQ. Classification accuracy for the new rating scale was described for a "dose-response" of effort. Disincentives for malingering detection in the PCE were identified.

A new interference score for the Stroop test.

A New interference calculation method for the Stroop test was developed based upon a neuropsychological model of the suppression of word reading in favor of color naming. Polynomial regression equations show a significant relationship between word reading and the New interference score that closely fits the underlying prediction of the New model, while the Golden [Stroop Color and Word Test, Stoelting Co., IL, Wood Dale, 1978] model (Old) produces only a random relationship. Constructs of developmental maturation and lateralized brain damage are supported by the New but not the Old method. The New compared to the Old method also gives a significant reduction in scores in a small sample of demented patients. It would be advisable to use this New model in both cognitive and neuropsychological comparisons of different lesions or different stimulus and response demands. The New model will also help promote finer clinical inferences when an understanding relative to the patient's own baselines is necessary.

Geomagnetic Orienting in the Radial Eight-Arm Maze?

The purpose of this selected, theoretical review is to propose an account for radial-maze behavior in the rat. It is suggested that performance in the Olton radial eight-arm maze is similar to navigational performance in other species, and that this radial-maze performance can be acquired as a consequence of the rat's responding to geomagnetic cues. The distinction between cognitive mapping and working memory is not a useful one in this proposal for two reasons: (a) the original radial-maze task permitted both strategies; and (b) a consideration of ecologically relevant variables leads to a different experimental question. That question is, What are the salient cues for rat navigation under different ecologically meaningful conditions?