Article

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

ABSTRACT 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.

3 Bookmarks
 · 
253 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this archival study was to identify performance validity tests (PVTs) and standard IQ and neurocognitive test scores, which singly or in combination, differentiate credible patients of low IQ (FSIQ ≤ 75; n = 55) from non-credible patients. We compared the credible participants against a sample of 74 non-credible patients who appeared to have been attempting to feign low intelligence specifically (FSIQ ≤ 75), as well as a larger non-credible sample (n = 383) unselected for IQ. The entire non-credible group scored significantly higher than the credible participants on measures of verbal crystallized intelligence/semantic memory and manipulation of overlearned information, while the credible group performed significantly better on many processing speed and memory tests. Additionally, credible women showed faster finger-tapping speeds than non-credible women. The credible group also scored significantly higher than the non-credible subgroup with low IQ scores on measures of attention, visual perceptual/spatial tasks, processing speed, verbal learning/list learning, and visual memory, and credible women continued to outperform non-credible women on finger tapping. When cut-offs were selected to maintain approximately 90% specificity in the credible group, sensitivity rates were highest for verbal and visual memory measures (i.e., TOMM trials 1 and 2; Warrington Words correct and time; Rey Word Recognition Test total; RAVLT Effort Equation, Trial 5, total across learning trials, short delay, recognition, and RAVLT/RO discriminant function; and Digit Symbol recognition), followed by select attentional PVT scores (i.e., b Test omissions and time to recite four digits forward). When failure rates were tabulated across seven most sensitive scores, a cut-off of ≥ 2 failures was associated with 85.4% specificity and 85.7% sensitivity, while a cut-off of ≥ 3 failures resulted in 95.1% specificity and 66.0% sensitivity. Results are discussed in light of extant literature and directions for future research.
    The Clinical Neuropsychologist 07/2014; 28(6):1-23. · 1.58 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The main goal of a severe impairment profile (SIP) on a performance validity test (PVT) is to help reduce the false-positive rate when identifying non-credible effort in people who are truly impaired. A secondary goal is to help with clinical judgment about impairment itself. Although there is adequate specificity for the SIP in severely impaired individuals, a large proportion of simulators can produce an SIP. Given that Social Security Disability (SSD) claimants are typically low functioning and also seeking compensation, it was of interest to know whether the SIP can be used to exclude truly low-functioning claimants, or whether SSD claimants identified as malingering also produce the SIP, as the simulators in a recent study of this profile. By comparing the SSD claimants to a group of low-functioning Child Protection (CP) claimants who were motivated to do well in order to get their children returned from State custody, the findings clearly show that the SIP is easily produced in criterion-malingerers, but not in those low-functioning CP claimants motivated to do well.
    Archives of Clinical Neuropsychology 03/2013; · 2.00 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Symptom Validity Scale (SVS) for low-functioning individuals (Chafetz, Abrahams, & Kohlmaier, 2007) employs embedded indicators within the Social Security Psychological Consultative Examination (PCE) to derive a score validated for malingering against two criterion tests: Test of Memory Malingering (TOMM) and Medical Symptom Validity Test (MSVT). When any symptom validity test is used with Social Security claimants there is a known rate of mislabeling (1-specificity), essentially calling a performance biased (invalid) when it is not, also known as a false-positive error. The great costs of mislabeling an honest claimant necessitated the present study, designed to show how multiple positive findings reduce the potential for mislabeling. This study utilized a known-groups design to address the impact of using multiple embedded indicators within the SVS on the diagnostic probability of malingering. Using four SVS components, Sequence, Ganser, and Coding errors, along with Reliable Digit Span (RDS), the positive predictive power was computed directly or by the chaining of likelihood ratios. The posterior probability of malingering increased from one to two to three failed indicators. With three failed indicators, there were essentially no false positive errors, and the total SVS score was in the range consistent with Definite Malingering, as shown in Chafetz et al. (2007). Thus, in a typical PCE when an examiner might have only a few embedded indicators, more confidence in a diagnosis of malingering might be obtained with a finding of multiple failures.
    The Clinical Neuropsychologist 07/2011; 25(7):1239-52. · 1.68 Impact Factor