Malingering on the Social Security Disability Consultative Exam: A New Rating Scale

Abstract

In disability examinations, benefits may depend on the findings of a psychological consultative examination (PCE), which in Louisiana usually involves a mental status examination and a Wechsler Scale. The disability determinations service (DDS) requires a warning that failure to do one's best may result in an unfavorable decision on the claim, but psychologists are officially discouraged from determining effort by the use of formal effort tests. Consequently, there is a need for internal indicators of effort. Formal testing of effort was undertaken in order to identify indicators of effort within the PCE in WAIS-age and WISC-age claimants. Our findings indicated that the total score of indicators was more predictive of effort than any single indicator. Regression equations yielded information on how much effort contributes to IQ. Classification accuracy for the new rating scale was described for a "dose-response" of effort. Disincentives for malingering detection in the PCE were identified.

The implications of symptom validity test failure for ability-based test performance in a pediatric sample.

“…The frequency with which adults provide noncredible effort during neuropsychological evaluation is fairly well studied, with rates ranging from less than 10% in general medical cases to 40% in mild traumatic brain injury (TBI) litigants to even higher in some other secondary gain contexts (Chafetz, Abrahams, & Kohlmaier, 2007;Grève, Etherton, Ord, Bianchini, & Curtis, 2009;Larrabee, 2003;Mittenberg, Patton, Canyock, & Condit, 2002).…”

Postconcussive Symptom Exaggeration After Pediatric Mild Traumatic Brain Injury

“…43 In brief, the evaluating neuropsychologists judged the reasons to be varied and to relate to secondary gain issues (eg, getting out of schoolwork or sports), as well as to direct psychological factors (eg, somatization) and indirect ones (eg, depression leading to a "plea for help"). Although children are capable of feigning cognitive problems in pursuit of financial gain, 38,44,45 litigation status did not relate to MSVT failure in this sample.…”

“…[34][35][36][37] Outright malingering is apt to occur less frequently in children, although multiple case reports and case series have documented that children provide noncredible responses at least occasionally during health care examinations. [38][39][40][41][42][43][44][45][46][47][48][49][50] Only 1 identified study has focused on how frequently noncredible responding occurs after pediatric mTBI specifically. A consecutive neuropsychological case series of ours consisting of 193 school-aged children found that 17% of the sample failed a performance validity test (PVT).…”

Effort-testing In Children Undergoing PsychoEducational Assessment Using The Medical Symptom Validity Test

“…These studies reported pass/fail rates of children comparable to those of adults making good effort regardless of age or abilities, with the exception of Social Security claimants, who had a much higher failure rate [5]. Kirkwood and Kirk, who administered the MSVT to pediatric patients with mild brain injury, did not find the pre-concussion diagnosis of a reading disorder contributed to the failure rate [14].…”

“…There is no agreed upon cut-off score for children, although some researchers have used the adult cut-off [3]. Only two studies have documented use of RDS with children: Chafetz, Abrahams, and Kohlmaier used the procedure as one of the variables in a model they designed to identify malingering in children and adults; Hargrave, Kirkwood, and Kirk examined sensitivity and specificity RDS with a sample of 275 mild-TBI clinical patients aged 8 to 16 [5] [11]. While a cut-off score of 7 or less produced an unacceptable high false positive rate (32%), the authors found that an RDS cut-off of 5 or less resulted in 51% sensitivity and 91% specificity, comparable with the results in adult studies.…”