Fraud in emotional harm and neuropsychological injury claims.
Specialized Tests of Poor Effort or Intentional Failure on Neuropsychological Assessments
Many neuropsychologists naively believe that they can detect malingering of cognitive deficits through analysis of the pattern of deficits on the numerous tests that make up a typical assessment battery. In one of the leading clinical psychology journals, a classic study published by some of the founders of neuropsychology established that neuropsychologists couldn’t detect malingering of cognitive deficits at a level much better than chance without the use of specialized tests. One subsequent study found that not one of the participating 42 neuropsychologists could identify the profiles of children instructed to malinger cognitive impairments, though the clinicians expressed high confidence in their erroneous findings.
The impact of feigning or poor effort on the results of neuropsychological tests is profound. Recent research has found that effort accounts for more than half the variance in neuropsychological test scores, a much higher percentage of the variance than injury severity. Persons who put forth good effort scored better than persons who did not, regardless of the severity of the actual injury. The domain most affected by effort was memory and learning. People with mild head injury who failed effort tests scored 3.6 times further below the normal mean score than those in the known cerebral impairment group when assessed as part of a compensation claim.
Since these seminal studies, many tests have been developed to detect malingering of cognitive impairment. Yet many experts fail to use them. Many continue to use tests that were long ago shown ineffective in detecting feigners because of the ease of administration or low cost. One common example is the Rey 15 Item Test, which consists of a 3 x 5 array of numbers, letters and shapes in sequence. Several studies have shown that the Rey test lacks the ability to detect malingering (i.e., sensitivity) and distinguish genuine impairment (i.e., specificity). Its continued popularity and acceptance is not supported by scientific research since it detects malingering only when the claimant engages in blatant feigning of memory impairment.
The best-validated instruments currently available to detect malingered cognitive impairment are:
- Test of Memory Malingering (TOMM)—Uses pictorial stimuli. Widely respected and unaffected by depression or other psychiatric conditions, but produces more false positives than other tests (i.e., falsely states a claimant is feigning).
- Word Memory Test—Uses verbal recognition memory to measure suboptimal effort, which is a broader concept than intentional malingering. More sensitive than the TOMM to feigned memory impairment for claimants in litigation. Produces very minimal false positives among a diverse range of groups (brain injured, depressed, children with fetal alcohol syndrome, schizophrenia, ADHD, Bipolar Disorder, Conduct Disorder, Oppositional Defiant Disorder, Learning Disabilities, various ages, and various reading levels at or above 3rd grade).
- Computerized Assessment of Response Bias—Uses computer administered visual number recognition.
- Portland Digit Recognition Test—Uses auditory number recognition.
- Victoria Symptom Validity Test—Assesses effort and feigning of memory complaints using a computer administered forced choice test of visual number recognition.
