The effects of motivation, coaching, and knowledge of neuropsychology on the simulated malingering of head injury

Department of Psychology, The Colorado College, 14 East Cache La Poudre Street, Colorado Springs, CO 80903, USA.
Archives of Clinical Neuropsychology (Impact Factor: 1.99). 02/2004; 19(1):73-88. DOI: 10.1016/S0887-6177(02)00214-7
Source: PubMed


Two student groups, introductory psychology (n=91) and advanced neuroscience (n=34) undergraduates, were asked to malinger a head injury on Rey's 15-Item Test (FIT) and Dot Counting Test (DCT). The participants
were randomly assigned to one of three motivation conditions (no motivation given, compensation, avoidance of blame for a
motor vehicle accident) and to one of three coaching conditions (no coaching, coaching post-concussive symptoms, coaching
symptoms plus warning of malingering detection). Analyses revealed a Motivation×Student Group interaction on the FIT, indicating
that the advanced neuroscience students, particularly when in the compensation condition, malingered the most flagrantly.
On the DCT, main effects for motivation and coaching on the qualitative variables and a Motivation×Coaching interaction on
the accuracy variables indicated that those in the compensation condition performed the most poorly, and that coaching plus
warning only tempers malingering on memory tasks, not timed tasks.

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    • "One commonly used study design to investigate malingering is a simulation design, where participants are instructed to simulate a condition (such as to malinger the cognitive symptoms of a TBI) while completing tests designed to detect exaggeration in order to assess test efficacy (Erdal, 2004; Heilbronner et al., 2009). Although simulation designs have a number of potential limitations, such as low external validity, inflation of observed specificity, and the potential for a lack of adequate motivation in participants to truly replicate the behavior of a malingerer, there are also a number of benefits (Erdal, 2004; Larrabee, 2007; Powell et al., 2004)—for example, confidence of group membership of participants, high internal validity, and confidence that the changes observed in the dependent variables are a result of the experimental manipulations (Larrabee, 2007; Vickery et al., 2004). "
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    ABSTRACT: The aims of the current study were to: (a) examine the predictive validity and efficacy of the Advanced Clinical Solutions Word Choice Test (WCT) as a measure of effort relative to the Test of Memory Malingering (TOMM); (b) investigate whether performing a dual (distraction) task would undermine performance on either test; (c) assess the effect of coaching on the diagnostic accuracy of both the WCT and the TOMM; and (d) establish an optimal cut score for the WCT. The current study used a simulation design based on an analogue design in which normal participants were instructed to either apply full effort or simulate a brain injury on the tasks without being detected. Participants included 93 undergraduate university students who were randomly assigned to 1 of 4 conditions: (a) distraction, (b) uncoached traumatic brain injury (TBI) simulators, (c) coached TBI simulators, or (d) full effort. The results demonstrated that the WCT and the TOMM were effective in detecting simulated cognitive impairment. Both tests were resistant to the effects of distraction and were equally effective in detecting coached and uncoached simulators. A cut score of 42 on the WCT was found to provide optimal specificity and sensitivity on the test.
    Full-text · Article · Aug 2014 · Applied Neuropsychology: Adult
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    • "In order to avoid increasing test battery administration time and to reduce the risk of coaching, researchers have encouraged the use of embedded indices of response bias derived from standard cognitive tests in the assessment of noncredible test performance (Boone, 2013; Bortnik et al., 2010; Erdal, 2004; Iverson & Binder, 2000; M. Kim et al., 2010). Use of multiple, effective, and independent performance validity tests (PVTs) can enhance a clinician's ability to detect noncredible test taking as negative response bias may fluctuate across time (Boone, 2009; Boone, 2013; Bush et al., 2005; Sweet & Nelson, 2007), and failures on multiple uncorrelated performance "
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    ABSTRACT: Practice guidelines recommend the use of multiple performance validity tests (PVTs) to detect noncredible performance during neuropsychological evaluations, and PVTs embedded in standard cognitive tests achieve this goal most efficiently. The present study examined the utility of the Comalli version of the Stroop Test as a measure of response bias in a large sample of "real world" noncredible patients (n = 129) as compared with credible neuropsychology clinic patients (n=233). The credible group performed significantly better than the noncredible group on all trials, but particularly on word-reading (Stroop A) and color-naming (Stroop B); cut-scores for Stroop A and Stroop B trials were associated with moderate sensitivity (49-53%) as compared to the low sensitivity found for the color interference trial (29%). Some types of diagnoses (including learning disability, severe traumatic brain injury, psychosis, and depression), very advanced age (⩾80), and lowered IQ were associated with increased rates of false positive identifications, suggesting the need for some adjustments to cut-offs in these subgroups. Despite some previous reports of an inverted Stroop effect (i.e., color-naming worse than color interference) in noncredible subjects, individual Stroop word reading and color naming trials were much more effective in identifying response bias.
    Full-text · Article · Jun 2013 · The Clinical Neuropsychologist
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    • "In their review of the SVT coaching literature Suhr and Gunstad (2007) underline the importance of the content of coaching in determining whether it is successful in helping participants avoid detection. Coaching about traumatic brain injury (TBI) symptoms alone has been ineffective in raising SVT scores in some studies (e.g., Powell, Gfeller, Hendricks, & Sharland, 2004), but effective in others (Erdal, 2004; Suhr & Gunstad, 2000). Coaching specific to test-taking strategies has also produced inconsistent results, with some studies finding improved SVT scores (e.g., Cato, Brewster, Ryan, & Guiliano, 2002; Powell et al., 2004), but others finding no difference (e.g., Frederick & Foster, 1991; Inman et al., 1998). "
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    ABSTRACT: Evaluation of resistance to coaching is an important step in the validation of symptom validity tests (SVTs) for clinical use in neuropsychological evaluations. In the present study coaching effects were evaluated for two recently developed SVTs, the Medical Symptom Validity Test (MSVT) and Nonverbal Medical Symptom Validity Test (NVMSVT) as compared with a well-validated existing SVT, the Test of Memory Malingering (TOMM). This study used a simulation design that included 103 healthy younger study volunteers who were randomly assigned into one of four conditions: Symptom Coaching, Test Coaching, Combined Coaching, or Best Effort Control. Specificity for all SVTs was excellent (96-100%). Test Coaching, either alone or combined with Symptom Coaching, was more effective than Symptom Coaching alone in producing raw scores suggestive of "better" effort for all SVTs. However, there were only modest declines in the obtained sensitivity, which remained above 80% for all SVTs. These results provide empirical support for the classification accuracy of the MSVT and NVMSVT, even when challenged with combined coaching interventions. However, further validation using known-groups designs and clinical samples is needed.
    Full-text · Article · May 2012 · The Clinical Neuropsychologist
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