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: 1.32). 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.

  • [Show abstract] [Hide abstract]
    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.
    Applied Neuropsychology 04/2011; 18(2):143-9. · 1.32 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
  • [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