Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns.

Trauma symptoms, recovery patterns, and life stressors of children between the ages of 9 and 18 (n = 387) following Hurricane Katrina were assessed using an adapted version of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool for Children and Adolescents (National Child Traumatic Stress Network, 2005). Based on assessments 2 and 3 years after the hurricane, most children showed a decrease in posttraumatic stress and depression symptoms over time. Students were also classified into outcome trajectories of stress resistant, normal response and recovery, delayed breakdown, and breakdown without recovery (A. S. Masten & J. Obradovic, 2008). Age, gender, and life stressors were related to these recovery patterns. Overall, the findings highlight the importance of building and maintaining supportive relationships following disasters.

Posttraumatic stress symptoms in children after Hurricane Katrina: predicting the need for mental health services.

The purpose of this study was to examine factors related to the development of posttraumatic stress symptoms in children and adolescents after Hurricane Katrina. It was hypothesized that a positive correlation would exist between trauma exposure variables and symptoms indicating need for mental health services experienced 2 years after Hurricane Katrina. Specifically, the authors hypothesized that experiences associated with natural disaster including personal loss, separation from family and/or community, and lack of community support as well as previous loss or trauma would be related to increased symptomatology in both children and adolescents. This study included 7,258 children and adolescents from heavily affected Louisiana parishes. Measures included the Hurricane Assessment and Referral Tool for Children and Adolescents developed by the National Child Traumatic Stress Network (NCTSN, 2005). Results were generally supportive of our hypotheses, and specific exposure and demographic variables were found to be strongly related to posttraumatic stress symptoms in children and adolescents.

The vulnerability to coaching across measures of effort.

Neuropsychologists are increasingly called upon to conduct evaluations with individuals involved in personal injury litigation. While the inclusion of measures of effort within a test battery may help clinicians determine whether a client has put forth full effort, attorney coaching may allow dishonest clients to circumvent these efforts. The purpose of this study was to determine the degree to which frequently used measures of effort are susceptible to coaching, as well as to explore and classify strategies undertaken by coached malingering simulators. Overall, coached simulators performed significantly better on 7 of 14 measured variables. Potential improvements in the external validity of the simulation design were also explored.

Detecting malingering in traumatic brain injury and chronic pain: a comparison of three forced-choice symptom validity tests.

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. Clinical and research implications are discussed.

Sensitivity and specificity of MMPI-2 validity scales and indicators to malingered neurocognitive dysfunction in traumatic brain injury.

The present study used a known-groups design to determine the classification accuracy of 10 MMPI-2 validity scales and indicators in the detection of cognitive malingering in traumatic brain injury. Participants were 259 traumatic brain injury and 133 general clinical patients seen for neuropsychological evaluation. The TBI patients were subdivided into groups based on a comprehensive examination of effort following Slick, Sherman, and Iverson's (1999) criteria. More extreme scores demonstrated excellent specificity; often impressive sensitivity was seen even while maintaining a low false positive error rate. Specificity was good even in stroke, memory disorder, and psychiatric patients without incentive. The results of this study are presented in frequency tables that can be easily referenced in clinical practice.

Are we honestly studying malingering? A profile and comparison of simulated and suspected malingerers.

Malingering research typically uses analog simulation design or differential prevalence design among "real" patients. Both have been criticized for methodological limitations in external and internal validity, respectively. Samples of simulated malingerers were compared to suspected malingerers to examine generalizability of analog findings. Overall results support the use of simulation designs. Furthermore, it was demonstrated that stringent selection of suspected malingerers maintains internal validity of the differential prevalence design. A second focus, to determine if demographic matching of simulated malingerers is necessary, showed that matching on age and race is not necessary.

California verbal learning test indicators of Malingered Neurocognitive Dysfunction: sensitivity and specificity in traumatic brain injury.

The present study used well-defined traumatic brain injury (TBI) and mixed neurological (other than TBI) and psychiatric samples to examine the specificity and sensitivity to Malingered Neurocognitive Dysfunction (MND) of four individual California Verbal Learning Test (CVLT) variables and eight composite CVLT malingering indicators. Participants were 275 traumatic brain injury and 352 general clinical patients seen for neuropsychological evaluation. The TBI patients were assigned to one of five groups using the Slick, Sherman, and Iverson (1999) criteria: no incentive, incentive only, suspect, and malingering (both Probable MND and Definite MND). Within TBI, persons with the strongest evidence for malingering (Probable and Definite) had the most extreme scores. Good sensitivity (approximately 50%) in the context of excellent specificity (> 95%) was found in the TBI samples. Issues related to the appropriate clinical application of these data are discussed.

WAIS digit span-based indicators of malingered neurocognitive dysfunction: classification accuracy in traumatic brain injury.

The present study determined specificity and sensitivity to malingered neurocognitive dysfunction (MND) in traumatic brain injury (TBI) for several Wechsler Adult Intelligence Scale (WAIS) Digit Span scores. TBI patients (n = 344) were categorized into one of five groups: no incentive, incentive only, suspect, probable MND, and definite MND. Performance of 1,063 nonincentive patients (e.g., cerebrovascular accident, memory disorder) was also examined. Digit Span scores included reliable digit span, maximum span forward both trials correct, maximum span forward, combined maximum forward and backward span, Digit Span scaled score, maximum span backward both trials correct, and maximum span backward. In TBI, sensitivity to MND ranged from 15% to greater than 30% at specificities of 92% to 98%. Patient groups with documented brain pathology had higher false-positive error rates. These results replicate previous known-groups malingering studies and provide valuable data supporting the WAIS Digit Span scores in detection and diagnosis of malingering.

Temporal stability of the Wisconsin Card Sorting Test in a chronic traumatic brain injury sample.

The aim of the present study was to investigate the temporal stability of the Wisconsin Card Sorting Test (WCST) in a clinical population with documented brain pathology, stable cognitive deficits, and for whom repeated testing is common: chronic severe traumatic brain injury (TBI). Participants were 34 patients at least 1 year post severe TBI living at a large residential rehabilitation facility. The WCST was administered in standard fashion with both the standard and 64-card versions scored. All derived scores with norms were examined. Results indicated acceptable temporal stability of most scores for both the standard and short WCST, although the stability of the WCST-64 was poorer than for the standard WCST. Three sets of significant change indices are provided for clinical use.