Kevin W. Greve

The current study assessed performance validity on the S troop C olor and W ord T est ( S troop) in mild traumatic brain injury ( TBI ) using criterion‐groups validation. The sample consisted of 77 patients with a reported history of mild TBI . Data from 42 moderate–severe TBI and 75 non‐head‐injured patients with other clinical diagnoses were also examined. TBI patients were categorized on the basis of Slick, Sherman, and Iverson (1999) criteria for malingered neurocognitive dysfunction ( MND ). Classification accuracy is reported for three indicators ( W ord, C olor, and C olor– W ord residual raw scores) from the S troop across a range of injury severities. With false‐positive rates set at approximately 5%, sensitivity was as high as 29%. The clinical implications of these findings are discussed.

One third of all people will experience spinal pain in their lifetime and half of these will experience chronic pain. Pain often occurs in the context of a legally compensable event with back pain being the most common reason for filing a Workers Compensation claim in the United States. When financial incentives to appear disabled exist, malingered pain-related disability is a potential problem. Malingering may take the form of exaggerated physical, emotional, or cognitive symptoms and/or under-performance on measures of cognitive and physical capacity. Essential to the accurate detection of Malingered Pain-related Disability is the understanding that malingering is an act of will, the goal of which is to increase the appearance of disability beyond that which would naturally arise from the injury in question. This paper will review a number of Symptom Validity Tests (SVTs) that have been developed to detect malingering in patients claiming pain-related disability and will conclude with a review of studies showing the diagnostic benefit of combining SVT findings from a comprehensive malingering assessment. The utilization of a variety of tools sensitive to the multiple manifestations of malingering increases the odds of detecting invalid claims while reducing the risk of rejecting a valid claim.

This study examined the effects of traumatic brain injury (TBI) on Wechsler Memory Scale‐III (WMS‐III) performance. Since poor effort potentially contaminates results, effort was explicitly assessed and controlled using two well‐validated cognitive validity indicators, the Portland Digit Recognition Test (PDRT) and Reliable Digit Span (RDS). Participants were 44 mild TBI patients with good effort, 48 mild TBI patients with poor effort, and 40 moderate–severe TBI patients with good effort. A dose–response relationship between injury severity and WMS‐III performance was demonstrated. Effect size calculations showed that the good effort mild TBI patients did not differ from normal (average Cohen's d = 0.07) while moderate–severe TBI had a moderate effect on WMS‐III scores (average Cohen's d =−0.52). Consistent with previous literature, the moderate–severe TBI group scored the lowest on WMS‐III Visual indices. Effort had a larger effect than injury severity on WMS‐III scores (average Cohen's d =−1.27). Clinical implications of these findings are discussed.

The present study used criterion groups validation to determine the ability of the Millon Clinical Multiaxial Inventory–III (MCMI–III) modifier indices to detect malingering in traumatic brain injury (TBI). Patients with TBI who met criteria for malingered neurocognitive dysfunction (MND) were compared to those who showed no indications of malingering. Data were collected from 108 TBI patients referred for neuropsychological evaluation. Base rate (BR) scores were used for MCMI–III modifier indices: Disclosure, Desirability, and Debasement. Malingering classification was based on the Slick, Sherman, and Iverson (1999) Slick, D. J. , Sherman, E. M. S. and Iverson, G. L. 1999. Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13: 545–561. [Taylor & Francis Online], [Web of Science ®] [Google Scholar] criteria for MND. TBI patients were placed in one of three groups: MND (n = 55), not-MND (n = 26), or Indeterminate (n = 26).The not-MND group had lower modifier index scores than the MND group. At scores associated with a 4% false-positive (FP) error rate, sensitivity was 47% for Disclosure, 51% for Desirability, and 55% for Debasement. Examination of joint classification analysis demonstrated 54% sensitivity at cutoffs associated with 0% FP error rate. Results suggested that scores from all MCMI–III modifier indices are useful for identifying intentional symptom exaggeration in TBI. Debasement was the most sensitive of the three indices. Clinical implications are discussed.

A criterion-groups validation was used to determine the classification accuracy of the Seashore Rhythm Test (SRT) and Speech Sounds Perception Test (SSPT) in detecting malingered neurocognitive dysfunction (MND) in traumatic brain injury (TBI). TBI patients were classified into the following groups: (1) Mild TBI Not-MND (n = 24); (2) Mild TBI MND (n = 27); and (3) Moderate/Severe TBI Not-MND (n = 23). A sample of 90 general clinical patients was utilized for comparison. Results showed that both SRT correct and SSPT errors differentiated malingerers from non-malingerers in the Mild TBI sample. At 96% specificity, sensitivities were 37% for SRT correct and 59% for SSPT errors. Joint classification accuracy showed that the best accuracy was achieved when using a cut-off associated with a 4% false positive error rate in the Mild TBI sample. Specificity was considerably lower in the Moderate/Severe TBI and General Clinical groups. The clinical application of these findings is discussed.

This study used criterion groups validation (known-groups design) to examine the classification accuracy of the Reliable Digit Span test (RDS) in a large group of chronic pain patients referred for psychological evaluation. The sample consisted of 612 patients classified into one of six groups based on evidence of malingered pain-related disability (MPRD): No-Incentive, Not MPRD; Incentive-Only, Not MPRD; Indeterminate; Possible MPRD; Probable MPRD; Definite MPRD. A total of 30 college student simulators were also included. Lower average RDS scores and higher rates of RDS failure were seen in patients classified as MPRD and in simulators. Consistent with previous literature in a variety of populations, RDS < = 6 provided the most accurate differentiation between MPRD and non-MPRD pain patients. Clinical implications are discussed.

This study used criterion groups validation to determine the accuracy of the Test of Memory Malingering (TOMM) in detecting malingered pain-related disability (MPRD) across a range of cutoffs in chronic pain patients undergoing psychological evaluation (n = 604). Data from patients with traumatic brain injury (n = 45) and dementia (n = 59) are presented for comparison. TOMM scores decreased and failure rates increased as a function of greater external evidence of intentional under-performance. The TOMM detected from 37.5% to 60.2% of MPRD patients, depending on the cutoff. False positive (FP) error rates ranged from 0% to 5.1%. Accuracy data for Trial 1 are also reported. In chronic pain the original cutoffs produced no FP errors but were associated with high false negative error rates. Higher cutoffs increased sensitivity without adversely affecting specificity. The relevance of these findings to research and clinical practice is discussed.

Classification accuracy for the detection of malingered neurocognitive dysfunction (MND) in mild traumatic brain injury (TBI) is examined for two selected measures from the Conners' Continuous Performance Test–II (CPT–II) using criterion-groups validation. Individual and joint classification accuracies are presented for Omissions and Hit Reaction Time Standard Error across a range of scores comparing mild TBI malingering (n = 27), mild TBI not-malingering (n = 31), and moderate-to-severe (M/S) TBI not-malingering (n = 24) groups. At cutoffs associated with at least 95% specificity in both mild and M/S TBI, sensitivity to MND in mild TBI was 30% for Omissions, 41% for Hit Reaction Time Standard Error, and 44% using both indicators. These results support the use of the CPT–II as a reliable indicator for the detection of malingering in TBI when used as part of a comprehensive diagnostic system.