Abstract:Traumatic brain injury (TBI) occurs at a high incidence, involving millions of individuals in the U.S. alone. Related to this, there are large numbers of litigants and claimants who are referred annually for forensic evaluation. In formulating opinions regarding claimed injuries, the present review advises experts to rely on two sets of information: TBI outcome and neuropsychological dose-response studies of non-litigants and non-claimants, and response bias literature that has demonstrated the relatively high… Show more
“…Typically, neuropsychological evaluation is used to characterize the level and pattern of cognitive impairment for those who have sustained a TBI (Finnanger et al., ; Hellawell, Taylor, & Pentland, ; Satz et al., ). TBI is often the result of accidents that may involve litigation or secondary gain (Sweet, Goldman, & Guidotti Breting, ). These factors have been shown to influence the validity of one's performance on neuropsychological tests (Gouse, Thomas, & Solms, ).…”
IntroductionThe Forced‐choice Graphics Memory Test (FGMT) is a newly developed measure to assess feigned cognitive impairment. This study investigated the ability and reliability of FGMT for identification of malingering in patients with traumatic brain injury (TBI).MethodsThe FGMT was administered to 40 healthy volunteers instructed to respond validly (Healthy Control, H‐C), 40 healthy volunteers instructed to feign cognitive impairment (Healthy Malingering, H‐M), 40 severe TBI patients who responded validly (TBI control, TBI‐C), and 30 severe TBI patients who evidenced invalid performance (TBI malingering, TBI‐M).ResultsBoth malingering groups (H‐M and TBI‐M) performed much more poorly than the nonmalingering groups (H‐C and TBI‐C). The FGMT overall total score, score on easy items, and score on hard items differed significantly across the four groups. The total score showed the highest classification accuracy in differentiating malingering from nonmalingering. A cutoff of less than 18 (total items) successfully identified 95% of TBI‐C and 93.3% of TBI‐M participants. The FGMT also demonstrated high test–retest reliability and internal consistency. FGMT scores were not affected by TBI patients' education, gender, age, or intelligence.ConclusionOur results suggest that the FGMT can be used as a fast and reliable tool for identification of feigned cognitive impairment in patients with TBI.
“…Typically, neuropsychological evaluation is used to characterize the level and pattern of cognitive impairment for those who have sustained a TBI (Finnanger et al., ; Hellawell, Taylor, & Pentland, ; Satz et al., ). TBI is often the result of accidents that may involve litigation or secondary gain (Sweet, Goldman, & Guidotti Breting, ). These factors have been shown to influence the validity of one's performance on neuropsychological tests (Gouse, Thomas, & Solms, ).…”
IntroductionThe Forced‐choice Graphics Memory Test (FGMT) is a newly developed measure to assess feigned cognitive impairment. This study investigated the ability and reliability of FGMT for identification of malingering in patients with traumatic brain injury (TBI).MethodsThe FGMT was administered to 40 healthy volunteers instructed to respond validly (Healthy Control, H‐C), 40 healthy volunteers instructed to feign cognitive impairment (Healthy Malingering, H‐M), 40 severe TBI patients who responded validly (TBI control, TBI‐C), and 30 severe TBI patients who evidenced invalid performance (TBI malingering, TBI‐M).ResultsBoth malingering groups (H‐M and TBI‐M) performed much more poorly than the nonmalingering groups (H‐C and TBI‐C). The FGMT overall total score, score on easy items, and score on hard items differed significantly across the four groups. The total score showed the highest classification accuracy in differentiating malingering from nonmalingering. A cutoff of less than 18 (total items) successfully identified 95% of TBI‐C and 93.3% of TBI‐M participants. The FGMT also demonstrated high test–retest reliability and internal consistency. FGMT scores were not affected by TBI patients' education, gender, age, or intelligence.ConclusionOur results suggest that the FGMT can be used as a fast and reliable tool for identification of feigned cognitive impairment in patients with TBI.
“… Figure 3. This illustration is from Suchy et al [ 66 ] and demonstrates the dose–response relationship frequently reported between increasingly lower SVT performance and actual neuropsychological test findings [ 3 ]. Mean composite WMS-III T-score for individuals in the four groups were calclated: Valid = patients who produced above cut-score SVT performance during initial administration; Improvers = patients who initially produced non-valid SVT performance, but the repeat administration after confrontation yielded valid results; Non-improvers = patients who produced non-valid SVT performance initially and again after confrontation; N-CONF = patients who initially produced non-valid VSVT performance but were not confronted.…”
Section: What Modifies Svt and Neuropsychological Test Performance?mentioning
confidence: 84%
“…Figure 3 shows this comparison. First, what is evident in viewing this figure is the so-called dose–response relation between level of SVT performance and neuropsychological test performance, in this case WMS-III performance [ 3 ]. Passing on the first SVT administration resulted in the highest performance, with below cut-point performance related to lower WMS-III performance.…”
Section: What Modifies Svt and Neuropsychological Test Performance?mentioning
confidence: 99%
“…Validity of neuropsychological test findings has become a critical issue in the assessment of neurocognitive and neurobehavioural sequelae, where hundreds of Brain Injury articles and published abstracts include statements about or information on what has been referred to as symptom validity testing (SVT). Currently, SVT research is a dominant theme in the field of neuropsychological assessment [ 3 , 4 ]. As will be discussed in this review, the SVT term may not be the best to use in this context, but for brevity this common acronym will be retained because of its entrenched use in current neuropsychological literature [ 4 ].…”
Background: To understand the neurocognitive effects of brain injury, valid neuropsychological test findings are paramount.
Review: This review examines the research on what has been referred to a symptom validity testing (SVT). Above a designated cut-score signifies a ‘passing’ SVT performance which is likely the best indicator of valid neuropsychological test findings. Likewise, substantially below cut-point performance that nears chance or is at chance signifies invalid test performance. Significantly below chance is the sine qua non neuropsychological indicator for malingering. However, the interpretative problems with SVT performance below the cut-point yet far above chance are substantial, as pointed out in this review. This intermediate, border-zone performance on SVT measures is where substantial interpretative challenges exist. Case studies are used to highlight the many areas where additional research is needed. Historical perspectives are reviewed along with the neurobiology of effort. Reasons why performance validity testing (PVT) may be better than the SVT term are reviewed.
Conclusions: Advances in neuroimaging techniques may be key in better understanding the meaning of border zone SVT failure. The review demonstrates the problems with rigidity in interpretation with established cut-scores. A better understanding of how certain types of neurological, neuropsychiatric and/or even test conditions may affect SVT performance is needed.
“…3 is whether the Bfailed^SVT/PVT performance has any bearing on the neuropsychological test results and should they be interpreted? Incontrovertible findings at a group level consistently show significantly reduced neuropsychological test results in the group that Bfails^the SVT/PVT measure(s) compared to the Bpass^group even controlling for other demographic and disease/injury variables (Sollman and Berry 2011;Sweet et al 2013). While group data may be informative, the real issue for the clinician is what decisions to make with the individual case.…”
How neuropsychological assessment findings are deemed valid has been a topic of numerous articles but few have addressed any role that neuroimaging studies could provide. Within military and various clinical samples of individuals undergoing neuropsychological evaluations, high levels of failure on measures of symptom validity testing (SVT) and/or performance validity testing (PVT) have been reported. Where 'failure' is defined as a below cut-score performance on some pre-determined set-point on a SVT/PVT measure, are such failures always indicative of invalid test findings or are there other explanations, especially based on informative neuroimaging findings? This review starts with the premise that even though the SVT/PVT task is designed to be simple and easy to perform, it nonetheless requires intact frontoparietal attention, working memory and task engagement (motivation) networks. If there is damage or pathology within any aspect of these networks as demonstrated by neuroimaging findings, the patient may perform below the cut-point as a result of the underlying damage or pathophysiology. The argument is made that neuroimaging findings should be considered as to where SVT/PVT cut-points are established and there should be much greater flexibility in SVT/PVT measures based on other personal, demographic and neuroimaging information. Several case studies are used to demonstrate these points.
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