American Academy of Clinical Neuropsychology Consensus Conference Statement on the Neuropsychological Assessment of Effort, Response Bias, and Malingering

Abstract

During the past two decades clinical and research efforts have led to increasingly sophisticated and effective methods and instruments designed to detect exaggeration or fabrication of neuropsychological dysfunction, as well as somatic and psychological symptom complaints. A vast literature based on relevant research has emerged and substantial portions of professional meetings attended by clinical neuropsychologists have addressed topics related to malingering (Sweet, King, Malina, Bergman, & Simmons, 2002). Yet, despite these extensive activities, understanding the need for methods of detecting problematic effort and response bias and addressing the presence or absence of malingering has proven challenging for practitioners. A consensus conference, comprised of national and international experts in clinical neuropsychology, was held at the 2008 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN) for the purposes of refinement of critical issues in this area. This consensus statement documents the current state of knowledge and recommendations of expert clinical neuropsychologists and is intended to assist clinicians and researchers with regard to the neuropsychological assessment of effort, response bias, and malingering.

Functional (Psychogenic) Cognitive Disorders: A Perspective from the Neurology Clinic

“…Someone who has a functional memory disorder should be able to report with reasonable accuracy what their normal day to day function and interactions are like. Considerable data exists on validity/effort testing mainly in the context of medicolegal assessment after brain injury [39].…”

Neuropsychological Sequelae of PTSD and TBI Following War Deployment among OEF/OIF Veterans

“…As with civilian samples (e.g., Heilbronner et al, 2009;Belanger et al, 2005), evidence suggests the importance of examining the effects of evaluation context and effort during testing on neuropsychological performance in OEF/OIF Veterans with deployment-related mTBI (Nelson et al, 2010;Armistead-Jehle, 2010;Whitney, Shepard, Williams, Davis, & Adams, 2009). A survey of studies reveals that some Veterans demonstrate insufficient effort during neuropsychological testing, with estimates ranging from 17% of a sample with a history of mTBI performing poorly on at least two effort tests (Whitney et al, 2009) …”

Subjective cognitive complaints and neuropsychological test performance following military-related traumatic brain injury

“…First, we excluded participants from the final sample for poor cognitive effort based on a single symptom validity measure (i.e., WMT). While the WMT is considered to be a clinically valid and reliable measure, current clinical guidelines recommend using more than one symptom validity measure for the purposes of detecting poor cognitive effort [66][67]. It is possible that we included some people who had been misidentified as providing adequate effort when, in fact, they provided inadequate effort.…”