Moral Reminders Do Not Reduce Symptom Over-Reporting Tendencies

Abstract

Is presenting patients with moral reminders prior to psychological testing a fruitful deterrence strategy for symptom over-reporting? We addressed this question in three ways. In study 1, we presented individuals seeking treatment for ADHD complaints (n = 24) with moral primes using the Mother Teresa Questionnaire and compared their scores on an index of symptom over-reporting (i.e., the Structured Inventory of Malingered Symptomatology, SIMS) with those of unprimed patient controls (n = 27). Moral primes slightly decreased SIMS scores, but the effect was not significant. In study 2, we took a different approach to activate moral categories: we recruited individuals seeking treatment for ADHD complaints and asked some of them to sign a moral contract (i.e., prime; n = 19) declaring that they would complete the tests in an honest way and compared their scores on the SIMS and standard clinical scales measuring self-reported psychopathology with those of unprimed patient controls (n = 17). Again, we found no convincing evidence that moral cues suppress symptom over-reporting. In study 3, we gave individuals from the general population (N = 132) positive, negative, or neutral moral primes and implicitly induced them to feign symptoms, after which they completed a brief validated version of the SIMS and an adapted version of the b Test (i.e., an underperformance measure). Again, primes did not affect over-reporting tendencies. Taken together, our findings illustrate that moral reminders are not going to be useful in clinical practice. Rather, they point towards the importance of studying contextual and individual difference factors that guide moral decision-making in patients and may be modified to discourage symptom over-reporting.

Flipping the Script: Measuring Both Performance Validity and Cognitive Ability with the Forced Choice Recognition Trial of the RCFT

“…Moreover, emerging evidence suggests that the instructions given to examinees have a weak effect on the credibility of their response sets overall ( Abeare, Hurtubise, et al., 2020 ; Niesten et al., 2017 ). In other words, reminding real-world patients to provide valid data does not assure that outcome.…”

“…By extending our investigation to clinical patients and adding an incentivized control group, we addressed several limitations of prior studies that were based on an experimental malingering paradigm ( Abeare, Hurtubise, et al., 2020 ; Erdal, 2004 ; Niesten et al., 2017 ). We incorporated two of the same criterion PVTs from the original study ( Rai et al., 2019 ) into the present analyses, permitting a direct comparison between past and present research.…”

Scores in Self-Report Questionnaires Assessing Adult ADHD Can Be Influenced by Negative Response Bias but Are Unrelated to Performance on Executive Function and Attention Tests

“…Van Impelen et al ( 2014) identified a good ability of SIMS to distinguish between groups of pre-instructed simulators and control groups in relation to simulated psychopathological symptoms. In an ADHD context, the results generated by SIMS remained stable even where the person administering the test made a strong moral appeal to the subject's honesty (Niesten et al, 2017). Scores equal to or greater than 20 were classified as invalid (Van Impelen et al, 2014).…”

Symptom and Performance Validity Assessment in European Countries: an Update

“…In addition to deception detection, Dutch research on SVA is characterized by conceptual studies (e.g., Merckelbach et al, 2019). Experimental studies have examined whether moral primes (Niesten et al, 2017) and feedback (Merckelbach et al, 2015) can deter symptom overreporting tendencies. Also, studies have looked into the consequences of symptom and performance invalidity (e.g., Merckelbach et al, 2014a;Roor et al, 2021).…”