[Show abstract][Hide abstract] ABSTRACT: United States Veterans of the Iraqi (Operation Iraqi Freedom (OIF)) and Afghanistan (Operation Enduring Freedom (OEF)) conflicts have frequently returned from deployment after sustaining mild traumatic brain injury (mTBI) and enduring stressful events resulting in posttraumatic stress disorder (PTSD). A large number of returning servicemembers have been diagnosed with both a history of mTBI and current PTSD. Substantial literature exists on the neuropsychological factors associated with mTBI and PTSD occurring separately; far less research has explored the combined effects of PTSD and mTBI. The current study employed neuropsychological and psychological measures in a sample of 251 OIF/OEF Veterans to determine whether participants with a history of mTBI and concurrent PTSD (mTBI+PTSD) have poorer cognitive and psychological outcomes than participants with mTBI only (mTBI-o), PTSD only (PTSD-o), or Veteran controls (VC), when groups are comparable on IQ, education, and age. The mTBI+PTSD group performed more poorly than VC, mTBI-o, and PTSD-o groups on several neuropsychological measures. Effect size comparisons suggest small deleterious effects for mTBI-o on measures of processing speed and visual attention and small effects for PTSD-o on measures of verbal memory, with moderate effects for mTBI+PTSD on the same variables. Additionally, the mTBI+PTSD group was significantly more psychologically distressed than the PTSD-o group, and PTSD-o group was more distressed than VC and mTBI-o groups. These findings suggest Veterans with mTBI+PTSD perform significantly lower on neuropsychological and psychiatric measures than Veterans with mTBI-o or PTSD-o. The results also raise the possibility of persisting cognitive changes following mTBI sustained during deployment.
Journal of Neurotrauma 10/2014; · 3.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Since the early 2000s concern has increased that college students might feign ADHD in pursuit of academic accommodations and stimulant medication. In response, several studies have validated tests for use in differentiating feigned from genuine ADHD. Although results have generally been positive, relatively few publications have addressed the possible impact of the presence of psychological disorders comorbid with ADHD. Because ADHD is thought to have accompanying conditions at rates of 50% and higher, it is important to determine if the additional psychological disorders might compromise the accuracy of feigning detection measures. The present study extended the findings of Jasinski et al. (2011) to examine the efficacy of various measures in the context of feigned versus genuine ADHD with comorbid psychological disorders in undergraduate students. Two clinical groups (ADHD only and ADHD + comorbid psychological disorder) were contrasted with two non-clinical groups (normal controls answering honestly and normal participants feigning ADHD). Extending previous research to individuals with ADHD and either an anxiety or learning disorder, performance validity tests such as the Test of Memory Malingering (TOMM), the Letter Memory Test (LMT), and the Nonverbal Medical Symptom Validity Test (NV-MSVT) were effective in differentiating both ADHD groups from normal participants feigning ADHD. However, the Digit Memory Test (DMT) underperformed in this study, as did embedded validity indices from the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Woodcock Johnson Tests of Achievement-III (WJ-III).
The Clinical Neuropsychologist 09/2014; · 1.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Minnesota Multiphasic Personality Inventory-2-RF (MMPI-2-RF) validity scales were evaluated to determine accuracy when differentiating honest responding, random responding, genuine posttraumatic stress disorder (PTSD), and feigned PTSD. Undergraduate students (n = 109), screened for PTSD, were randomly assigned to 1 of 4 instructional groups: honest, feign PTSD, half random, and full random. Archival data provided clinical MMPI-2-RF profiles consisting of 31 veterans diagnosed with PTSD. Veterans were diagnosed with PTSD using a structured interview and had passed a structured interview for malingering. Validity scales working as a group had correct classification rates of honest (96.6%), full random (88.9%), genuine PTSD (80.7%), fake PTSD (73.1%), and half random (44.4%). Results were fairly supportive of the scales' ability to discriminate feigning and full random responding from honest responding of normal students as well as veterans with PTSD. However, the RF validity scales do not appear to be as effective in detecting partially random responding.
Journal of Personality Assessment 08/2013; · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Current combat veterans are exposed to many incidents that may result in mild traumatic brain injury (mTBI) and/or posttraumatic stress disorder (PTSD). While there is literature on the neuropsychological consequences of PTSD only (PTSD-o) and mTBI alone (mTBI-o), less has been done to explore their combined (mTBI+PTSD) effect. The goal of this study was to determine whether Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veterans with mTBI+PTSD have poorer cognitive and psychological outcomes than veterans with PTSD-o, mTBI-o, or combat exposure-only. The final sample included 20 OIF/OEF veterans with histories of self-reported deployment mTBI (mTBI-o), 19 with current PTSD (PTSD-o), 21 with PTSD and self-reported mTBI (mTBI+PTSD), and 21 combat controls (CC) (no PTSD and no reported mTBI). Groups were formed using structured interviews for mTBI and PTSD. All participants underwent comprehensive neuropsychological testing, including neurocognitive and psychiatric feigning tests. Results of cognitive tests revealed significant differences in performance in the mTBI+PTSD and PTSD-o groups relative to mTBI-o and CC. Consistent with previous PTSD literature, significant differences were found on executive (switching) tasks, verbal fluency, and verbal memory. Effect sizes tended to be large in both groups with PTSD. Thus, PTSD seems to be an important variable affecting neuropsychological profiles in the post-deployment time period. Consistent with literature on civilian mTBI, the current study did not find evidence that combat-related mTBI in and of itself contributes to objective cognitive impairment in the late stage of injury.
The Clinical Neuropsychologist 06/2013; · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traumatic brain injury (TBI) is the leading cause of death and disability in children and adolescents in the United States. This is a pilot study, which explores the discrimination of chronic TBI from normal controls using scalp EEG during a memory task. Tsallis entropies are computed for responses during an old-new memory recognition task. A support vector machine model is constructed to discriminate between normal and moderate/severe TBI individuals using Tsallis entropies as features. Numerical analyses of 30 records (15 normal and 15 TBI) show a maximum discrimination accuracy of 93% (p-value=7.8557E-5) using 4 features. These results suggest the potential of scalp EEG as an efficacious method for noninvasive diagnosis of TBI.
IEEE transactions on bio-medical engineering 10/2012; · 2.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The present meta-analysis provides the first meta-analysis of research on stand-alone neurocognitive feigning tests since publication of the preceding paper by Vickery, Berry, Inman, Harris & Orey (2001). Studies of dedicated neurocognitive feigning test performances in adults appearing in published or unpublished (theses and dissertations) sources through October 2010 were reviewed and subjected to stringent inclusion criteria to maximize the validity of results. Neurocognitive feigning tests were included only if at least three contrasts of criterion-supported honest patient groups and feigners were available. Tests that met criteria for review included the Victoria Symptom Validity Test, used as an anchor to compare Vickery and colleagues' results; Test of Memory Malingering, Word Memory Test, Letter Memory Test, and Medical Symptom Validity Test. Effect sizes and test parameters at published cut scores were compiled and compared. Results reflected large effect sizes for all measures (mean d = 1.55, 95% confidence interval [CI] = 1.48-1.63). Mean specificity was 0.90 (95% CI = 0.85-0.94). Mean sensitivity was 0.69 (95% CI = 0.63-0.75). Several moderators of effect size were identified, with certain manipulations resulting in a weakening of effect size. Unexpectedly, warning simulators to feign believably increased effect sizes.
Archives of Clinical Neuropsychology 12/2011; 26(8):774-89. · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recently there has been growing concern that college students may feign symptoms of ADHD in order to obtain academic accommodations and stimulant medication. Unfortunately research has only begun to validate detection tools for malingered ADHD. The present study cross-validated the results of Sollman, Ranseen, and Berry (2010) on the efficacy of several symptom validity tests for detection of simulated ADHD among college students. Undergraduates with a history of diagnosed ADHD were randomly assigned either to respond honestly or exaggerate symptoms, and were compared to undergraduates with no history of ADHD or other psychiatric disorders who were also randomly assigned to respond honestly or feign symptoms of ADHD. Similar to Sollman et al. (2010) and other recent research on feigned ADHD, several symptom validity tests, including the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), Digit Memory Test (DMT), Nonverbal Medical Symptom Validity Test (NV-MSVT), and the b Test were reasonably successful at discriminating feigned and genuine ADHD. When considered as a group, the criterion of failure of 2 or more of these SVTs had a sensitivity of. 475 and a specificity of 1.00.
The Clinical Neuropsychologist 11/2011; 25(8):1415-28. · 1.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An estimated 1.4 million Americans suffer from traumatic brain injury (TBI) each year. Current methods of detecting TBI, such as computerized tomography (CT), magnetic resonance imaging (MRI), and Positron Emission Tomography (PET) scanning are time-consuming and expensive. Here, the viability of a potentially more cost-effective means of detecting TBI is presented. Support vector machine (SVM) analyses are employed to classify 15 TBI and 15 normal individuals' EEG recordings taken during a working memory test. The features used by the SVM analyses include different sets of event-related Tsallis entropy functionals. The analyses demonstrate a strong correlation between the event-related functionals (ERFs) and the presence of TBI, attaining classification accuracies as high as 90%.
Biomedical Sciences and Engineering Conference (BSEC), 2011; 04/2011
[Show abstract][Hide abstract] ABSTRACT: Twenty-four studies utilizing the Wechsler Adult Intelligence Scale (WAIS) Digit Span subtest--either the Reliable Digit Span (RDS) or Age-Corrected Scaled Score (DS-ACSS) variant--for malingering detection were meta-analytically reviewed to evaluate their effectiveness in detecting malingered neurocognitive dysfunction. RDS and DS-ACSS effectively discriminated between honest responders and dissimulators, with average weighted effect sizes of 1.34 and 1.08, respectively. No significant differences were found between RDS and DS-ACSS. Similarly, no differences were found between the Digit Span subtest from the WAIS or Wechsler Memory Scale (WMS). Strong specificity and moderate sensitivity were observed, and optimal cutting scores are recommended.
Journal of Clinical and Experimental Neuropsychology 03/2011; 33(3):300-14. · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined the utility of the Minnesota Multiphasic Personality Inventory—2 Restructured Form (MMPI-2-RF) validity
scales for detecting feigning and exaggeration of attention-deficit/hyperactive disorder (ADHD) among college students. Under
a simulation study design, participants with and without ADHD were assigned to perform honestly or to feign or exaggerate
deficits related to ADHD while completing self-report symptom inventories. Participants instructed to feign produced symptom
profiles similar to honest clinical profiles and more severe than honest nonclinical profiles. Participants with ADHD instructed
to exaggerate produced less severe profiles than those instructed to feign and more severe profiles than clinical controls.
MMPI-2-RF scale Fp-r showed potential for use in malingered ADHD detection at a revised cut score, which was significantly
lower than the cut score suggested in the test manual; use of the revised cut score will require further validation. Scales
F-r, Fs, and FBS-r did not classify well, but should be assessed in future studies of malingered ADHD. Detection of exaggeration
was consistently poorer than detection of feigning.
[Show abstract][Hide abstract] ABSTRACT: The MMPI and MMPI-2 validity scales have long been accepted as standard tools in the assessment of feigned mental disorders
(FMD) based on their extensive empirical validation. Studies are now examining MMPI-2-RF with modified validity scales plus
the new Infrequent Somatic Responses Scale (FS) and the recently-adapted Response Bias Scale (RBS). The current investigation used a known-groups design to examine the
effectiveness of the MMPI-2-RF for differentiating FMD and feigned cognitive impairment (FCI) from patients with genuine disorders
for a large civil forensic sample. Criterion measures included the Structured Interview of Reported Symptoms-2 (SIRS-2) for
the FMD group, and below-chance performances on the Victoria Symptom Validity Test (VSVT) and the Test of Memory Malingering
(TOMM) for the FCI group. For FMD, both F-r and FP-r produced very large effect sizes (ds > 2.00). Moreover, the absence of severe elevations (≥80T) on F-r proved effective at ruling-out most FMD. For the current
study, a FP-r cut score ≥90T for FMD produced virtually no false-positives (0.01) and only a moderate level of false-alarms. As predicted
by its detection strategies, most MMPI-2-RF validity scales have limited effectiveness with the FCI group. However, FBS-r
and RBS may be useful in conjunction with other clinical data for ruling out FCI for genuine neuropsychological consults.
An entirely separate concern is whether certain diagnostic groups, such as major depression, will have marked elevations on
MMPI-2-RF scales thereby increasing the likelihood of false-positives. On this point, FP-r performed exceptionally well with unelevated scores (Ms < 55T) consistently across diagnostic categories.
KeywordsMalingering–Feigning–Feigned mental disorders–Feigned cognitive impairment–MMPI-2-RF–SIRS-2
Journal of Psychopathology and Behavioral Assessment 01/2011; 33(3):355-367. · 1.55 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The DSM criteria for identifying malingering are reviewed and found to be flawed on both conceptual and practical grounds. Alternative models for diagnosing feigned psychiatric, physical, and neuropsychological symptoms are presented. A number of useful features of these systems are highlighted for potential contributions to modified DSM criteria. It is recommended that the present DSM text on malingering be replaced with feigned psychiatric, physical, or neuropsychological symptoms and suggestions for developing criteria for this condition are made.
[Show abstract][Hide abstract] ABSTRACT: Significant motivations and incentives exist for young-adult students to seek a diagnosis of attention-deficit/hyperactivity disorder (ADHD). With ADHD information readily accessible on the Internet, today's students are likely to be symptom educated prior to evaluation. This may result in false-positive diagnoses, particularly when students are motivated to convey symptoms. We evaluated the utility of ADHD symptom checklists, neurocognitive tests, and measures initially developed to detect feigned neurocognitive or psychiatric dysfunction (symptom validity tests [SVTs]). The performance of 31 undergraduates financially motivated and coached about ADHD via Internet-derived information was compared to that of 29 ADHD undergraduates following medication washout and 14 students not endorsing symptomatology. Results indicated malingerers readily produced ADHD-consistent profiles. Symptom checklists, including the ADHD Rating Scale and Conners's Adult ADHD Rating Scale-Self-Rating Form: Long, were particularly susceptible to faking. Conners's Continuous Performance Test-II findings appeared more related to motivation than condition. Promising results were seen with all cognitive SVTs (Test of Memory Malingering [TOMM], Digit Memory Test, Letter Memory Test, and Nonverbal-Medical Symptom Validity Test), particularly TOMM Trial 1 when scored using Trial 2 criteria. All SVTs demonstrated very high specificity for the ADHD condition and moderate sensitivity to faking, which translated into high positive predictive values at rising base rates of feigning. Combining 2 or more failures resulted in only modest declines in sensitivity but robust specificity. Results point to the need for a thorough evaluation of history, cognitive and emotional functioning, and the consideration of exaggerated symptomatology in the diagnosis of ADHD.
[Show abstract][Hide abstract] ABSTRACT: In a cross-validation of results from L. O. Graue et al. (2007), standard psychological assessment instruments, as well as tests of neurocognitive and psychiatric feigning, were administered under standard instructions to 24 participants diagnosed with mild mental retardation (MR) and 10 demographically matched community volunteers (CVH). A 2nd group of 25 community volunteers was instructed to malinger MR (CVM) during testing. CVM participants obtained Wechsler Adult Intelligence Scale (3rd ed.; D. Wechsler, 1997) Full Scale Intelligence Quotient scores that were significantly lower than the demographically similar CVH group but comparable to the MR group, suggesting that CVM subjects feigned cognitive impairment. On the basis of standard cutting scores from test manuals or published articles, of the 11 feigning measures administered, only the Test of Memory Malingering (TOMM; T. N. Tombaugh, 1996) retention trial had a specificity rate >.90 in the MR group. However, the 2nd learning trial of the TOMM, as well as a short form of the Digit Memory Test (T. J. Guilmette, K. J. Hart, A. J. Guiliano, & B. E. Leininger, 1994), approached this level of specificity, with both at .88. These results raise concerns about the specificity rates at recommended cutting scores of commonly used feigning tests in defendants with MR.
[Show abstract][Hide abstract] ABSTRACT: Previous research has been equivocal on personality trait and psychopathology differences between temporal lobe and other types of epilepsy, as well as between patients with right and left temporal lobe seizure foci. In this study, personality differences between patients with right temporal (n=23), left temporal (n=21), and extratemporal (n=24) epilepsy were investigated using the NEO Personality Inventory-Revised (NEO-PI-R). No statistically significant differences were found on any of the NEO-PI-R domains or facet trait scales. There were also no significant differences between groups on the Minnesota Multiphasic Personality Inventory 2 (MMPI-2), a measure of psychopathology. However, mild elevations were seen in all groups on clinical scales related to physical symptoms, health concern, and depression. These data suggest there are no consistent personality or psychopathology differences, as measured by the NEO-PI-R and the MMPI-2, between patients with left temporal, right temporal, and extratemporal epilepsy whose seizures are localized using video/EEG monitoring.
[Show abstract][Hide abstract] ABSTRACT: The current study examined the effectiveness of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath and Tellegen, 2008) over-reporting indicators in civil forensic settings. The MMPI-2-RF includes three revised MMPI-2 over-reporting validity scales and a new scale to detect over-reported somatic complaints. Participants dissimulated medical and neuropsychological complaints in two simulation samples, and a known-groups sample used symptom validity tests as a response bias criterion. Results indicated large effect sizes for the MMPI-2-RF validity scales, including a Cohen's d of .90 for Fs in a head injury simulation sample, 2.31 for FBS-r, 2.01 for F-r, and 1.97 for Fs in a medical simulation sample, and 1.45 for FBS-r and 1.30 for F-r in identifying poor effort on SVTs. Classification results indicated good sensitivity and specificity for the scales across the samples. This study indicates that the MMPI-2-RF over-reporting validity scales are effective at detecting symptom over-reporting in civil forensic settings.
Archives of Clinical Neuropsychology 09/2009; 24(7):671-80. · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A taxometric analysis of 3 factor scales extracted from the Health Problem Overstatement (HPO) scale of the Psychological Screening Inventory (PSI; R. I. Lanyon, 1970, 1978) was performed on the data from 1,240 forensic and psychiatric patients. Mean above minus below a cut, maximum covariance, and latent-mode factor analyses produced results indicative of dimensional latent structure for the exaggerated health complaints construct. The outcome of this and several other recent taxometric investigations indicates that across 3 different domains of feigning (i.e., psychiatric symptoms, memory problems, and health complaints), the overall feigning construct is ordered continuously along 1 or more dimensions rather than partitioned into discrete categories of malingerers and nonmalingerers. These findings call for more research on the extent to which the different domains of feigning share 1 or more dimensions in common.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to explore the latent structure of feigned neurocognitive deficit. Scores on the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), and Victoria Symptom Validity Test (VSVT) served as indicators in a taxometric investigation of 527 compensation-seeking adults using three taxometric procedures -- mean above minus below a cut (MAMBAC), maximum covariance (MAXCOV), and latent-mode factor analysis (L-Mode). All three procedures showed evidence of dimensional latent structure. The fact that feigned neurocognitive symptomatology is ordered along a continuum rather than bifurcating into distinct categories has important implications for theory, research, and clinical practice.
Journal of Clinical and Experimental Neuropsychology 11/2008; 31(5):584-93. · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context.
Journal of the International Neuropsychological Society 10/2008; 14(5):842-52. · 2.70 Impact Factor