Trial 1 versus Trial 2 of the Test of Memory Malingering: Evaluating accuracy without a "gold standard".

This study examines the accuracy of the Test of Memory Malingering (TOMM), a frequently administered measure for evaluating effort during neurocognitive testing. In the last few years, several authors have suggested that the initial recognition trial of the TOMM (Trial 1) might be a more useful index for detecting feigned or exaggerated impairment than Trial 2, which is the source for inference recommended by the original instruction manual (Tombaugh, 1996). We used latent class modeling (LCM) implemented in a Bayesian framework to evaluate archival Trial 1 and Trial 2 data collected from 1,198 adults who had undergone outpatient forensic evaluations. All subjects were tested with 2 other performance validity tests (the Word Memory Test and the Computerized Assessment of Response Bias), and for 70% of the subjects, data from the California Verbal Learning Test-Second Edition Forced Choice trial were also available. Our results suggest that not even a perfect score on Trial 1 or Trial 2 justifies saying that an evaluee is definitely responding genuinely, although such scores imply a lower-than-base-rate probability of feigning. If one uses a Trial 2 cut-off higher than the manual's recommendation, Trial 2 does better than Trial 1 at identifying individuals who are almost certainly feigning while maintaining a negligible false positive rate. Using scores from both trials, one can identify a group of definitely feigning and very likely feigning subjects who comprise about 2 thirds of all feigners; only 1% of the members of this group would not be feigning. (PsycINFO Database Record

Preliminary evaluation of child self-rating using the Child Tourette Syndrome Impairment Scale.

AIM: To evaluate and compare how children with Tourette syndrome and parents rate tic and non-tic behavioral related impairment in home, school, and social domains; to compare these with clinician tic ratings; and to identify factors that may predict greater impairment. METHOD: In a sample of 85 Tourette syndrome and 92 healthy control families, the Child Tourette Syndrome Impairment Scale, designed for parent-report and which includes 37 items rated for tic and non-tic impairment, was administered to parents and, with the referent modified, to children ages 9 to 17 years. Tic severity was rated using the Yale Global Tic Severity Scale (YGTSS). Analyses utilized descriptive and multivariate statistics. RESULTS: Tourette syndrome children's and parents' impairment ratings were higher than HC (p<0.001) and correlated moderately (r=0.46 to 0.54; p<0.001). Children's and parents' tic impairment ratings correlated with YGTSS (r=0.36 to 0.37; p<0.001). Parents' average ratings were higher than children's for 19 tic and all 37 non-tic impairment items. For 29 items, children self-rated impairment higher for tics than non-tics. Diagnoses of attention-deficit-hyperactivity disorder and obsessive-compulsive disorder had larger effects on parent impairment ratings. INTERPRETATION: The Child Tourette Syndrome Impairment Scale appears informative for child self-rating in Tourette syndrome.

A Bayesian approach to mixed group validation of performance validity tests.

Mental health professionals often use structured assessment tools to help detect individuals who are feigning or exaggerating symptoms. Yet estimating the accuracy of these tools is problematic because no "gold standard" establishes whether someone is malingering or not. Several investigators have recommended using mixed group validation (MGV) to estimate the accuracy of malingering measures, but simulation studies show that typical implementations of MGV may yield vague, biased, or logically impossible results. In this article we describe a Bayesian approach to MGV that addresses and avoids these limitations. After explaining the concepts that underlie our approach, we use previously published data on the Test of Memory Malingering (TOMM; Tombaugh, 1996) to illustrate how our method works. Our findings concerning the TOMM's accuracy, which include insights about covariates such as study population and litigation status, are consistent with results that appear in previous publications. Unlike most investigations of the TOMM's accuracy, our findings neither rely on possibly flawed assumptions about subjects' intentions nor assume that experimental simulators can duplicate the behavior of real-world examinees. Our conceptual approach may prove helpful in evaluating the accuracy of many assessment tools used in clinical contexts and psycholegal determinations.

Criterion validity of the financial skills subscale of the direct assessment of functional status scale.

Among the severely mentally ill, some individuals with schizophrenia or schizoaffective disorder can manage their finances independently, while others depend upon a court-appointed guardian or a representative payee. The present study examined the criterion validity of the financial skills subscale of the Direct Assessment of Functional Status (DAFS) scale in classifying those who manage their finances independently from those who do not. Scores on the financial skills subscale of the DAFS scale of 25 severely mentally ill outpatients without a guardian/payee were compared to scores of 24 severely mentally ill outpatients with a guardian/payee; 25 non-mentally ill participants served as controls. Logistic regression analyses, Bayesian statistics, and Receiver Operating Characteristic analyses revealed moderate classification accuracy in a sample with mild cognitive impairment. These analyses were also conducted on Mini-Mental State Examination (MMSE) scores and revealed generally lower accuracy than the DAFS financial skills subscale. The DAFS financial skills subscale can inform the clinician's opinion about the financial capacity of the severely mentally ill.

The performance of incarcerated juveniles on the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA).

The MacArthur Competency Assessment Tool-Criminal Adjudication (MacCAT-CA) is a structured interview that assesses abilities related to an individual's competency to stand trial (CST). In the present study, we examined the performance of 247 juvenile offenders on the scales of the MacCAT-CA (Understanding, Reasoning, and Appreciation), along with several other variables (age, IQ, achievement level, experience with the juvenile justice system, and a screen for psychopathology) that may be related to CST. In general, results suggest that performance on the MacCAT-CA varied with age, with younger participants performing significantly worse than older juveniles. When compared with the normative data, the juveniles in the present sample demonstrated deficits in court-related skills measured by the MacCAT-CA across all age ranges. In addition, several other variables, including achievement level, intelligence level, and psychopathology, were differentially related to the three scales of the MacCAT-CA.