The A-Test: A Symptom Validity Indicator Embedded Within a Mental Status Examination for Social Security Disability

a Independent Practice , New Orleans , Louisiana.
Applied Neuropsychology (Impact Factor: 1.97). 04/2012; 19(2):121-6. DOI: 10.1080/09084282.2011.643953
Source: PubMed


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.

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    • "She also claimed improbable pathology when she claimed to " see dead people. " On the A-Test she made 6 errors, which is well over the cutoff for noncredible effort (Chafetz, 2012). Her MSVT findings indicated failure on IR and DR (80% both). "
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    ABSTRACT: 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.
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    ABSTRACT: 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.
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    ABSTRACT: 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.
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