Detection of Inadequate Effort on Neuropsychological Testing: A Meta-Analytic Review of Selected Procedures

Abstract

Thirty-two studies of commonly researched neuropsychological malingering tests were meta-analytically reviewed to evaluate their effectiveness in discriminating between honest responders and dissimulators. Overall, studies using the Digit Memory Test (DMT), Portland Digit Recognition Test (PDRT), 15-Item Test, 21-Item Test, and the Dot Counting Test had average effect sizes indicating that dissimulators obtain scores that are approximately 1.1 standard deviations below those of honest responders. The DMT separated the means of groups of honest and dissimulating responders by approximately 2 standard deviations, whereas the 21-Item Test and the PDRT separated the groups by nearly 1.5 and 1.25 standard deviations, respectively. The 15-Item Test and the Dot Counting Test were less effective, separating group means by approximately 3/4 of a standard deviation. Although the DMT, PDRT, 15-, and 21-Item Tests all demonstrated very high specificity rates, at the level of individual classification, the DMT had the highest sensitivity and overall hit-rate parameters. The PDRT and 15-Item Test demonstrated moderate sensitivity, whereas the 21-Item Test demonstrated poor sensitivity. The less than perfect sensitivities of all the measures included in this review argue against their use in isolation as malingering screening devices.

Detection of feigned ADHD in college students.

“…Booksh et al (2010) found good discrimination with the WMT, which, not surprisingly, was much better than masked researchers or independent clinicians at determining faking, although a clinical ADHD group was not included. Of note, both studies found that the found the 15-item test was less able to discriminate simulated ADHD from controls, a finding that has been found with other populations (Vickery et al, 2001).…”

“…The Digit Memory Test (DMT; Hiscock & Hiscock, 1989) is considered by many to be the gold standard of neurocognitive feigning tools when evaluating neurological patients. Meta-analytic reviews have suggested that the DMT exhibits the strongest sensitivity of all measures reviewed, as well as very high specificity (Vickery, Berry, Inman, Harris, & Orey; 2001). Similarly, the Letter Memory Test, Card Version (LMT; Inman et al, 1998; Schipper, Berry, Coen, & Clark, 2008), has also shown a strong ability to separate groups of known or probable feigning and honest individuals in neurological samples, according to a Hedges's g (a d -approximate effect size) of 1.79 (Sollman & Berry, 2008).…”

Introducing a forced choice recognition trial to the Rey Complex Figure Test.

“…In addition to superior signal detection profiles, aggregate measures use scores from tests administered at different time points during testing, thereby allowing performance validity to be sampled continuously throughout an assessment (Boone, 2009). The latter practice is consistent with the highest forensic standards (Bush et al, 2005; Heilbronner et al, 2009; Larrabee, 2012; Orey, Cragar, & Berry, 2000; Sweet & Nelson, 2007; Vickery et al, 2001).…”

“…In addition to superior signal detection profiles, aggregate measures use scores from tests administered at different time points during testing, thereby allowing performance validity to be sampled continuously throughout an assessment (Boone, 2009). The latter practice is consistent with the highest forensic stan- Denning, 2012;Greve et al, 2006;Rai & Erdodi, in press); WCT ϭ Word Choice Test (fail defined as Յ47; Barhon et al, 2015;Davis, 2014;Pearson, 2009); EI-7 ϭ Erdodi Index Seven (fail defined as Ն4; Erdodi, Roth, et al, 2014) dards (Bush et al, 2005;Heilbronner et al, 2009;Larrabee, 2012;Orey, Cragar, & Berry, 2000;Sweet & Nelson, 2007;Vickery et al, 2001).…”

Mild traumatic brain injury.

“…For further contrast, intentional feigning or malingering produces neurocognitive test scores that fall far into the impaired range, with an effect size of −1.43 standard deviations below their estimated true ability . Certain tests such as the forced-choice Digit Memory Test show even larger effect sizes equaling or exceeding 2.00 (Vickery, Berry, Inman, Harris, & Orey, 2001). Such effect sizes are of a very large magnitude, in the range obtained by persons with severe TBI or Alzheimer's disease, and are more than 20 times greater than the nonsignificant effects.…”