Jerid M. Fisher

Examining the Test of Memory Malingering Trial 1 and Word Memory Test Immediate Recognition as Screening Tools for Insufficient Effort

Assessing effort level during neuropsychological evaluations is critical to support the accuracy of cognitive test scores. Many instruments are designed to measure effort, yet they are not routinely administered in neuropsychological assessments. The Test of Memory Malingering (TOMM) and the Word Memory Test (WMT) are commonly administered symptom validity tests with sound psychometric properties. This study examines the use of the TOMM Trial 1 and the WMT Immediate Recognition (IR) trial scores as brief screening tools for insufficient effort through an archival analysis of a combined sample of mild head-injury litigants ( N = 105) who were assessed in forensic private practices. Results show that both demonstrate impressive diagnostic accuracy and calculations of positive and negative predictive power are presented for a range of base rates. These results support the utility of Trial 1 of the TOMM and the WMT IR trial as screening methods for the assessment of insufficient effort in neuropsychological assessments.

Hit rates of adequate performance based on the test of memory malingering (TOMM) Trial 1.

The Test of Memory Malingering (TOMM) is a method of identifying patients who may be exerting poor effort during neuropsychological testing. This study seeks to examine whether TOMM Trial 1 scores are useful in identifying patients whose overall TOMM performance does not indicate obvious poor effort. Hit rates of adequate performance on Trial 2 and the Retention Trial were calculated based on a fixed criterion of 45 or greater on Trial 1. Archival data were collected from a sample of 77 mild traumatic brain injured litigants and compared to each clinical sample described in the TOMM test manual (Tombaugh, 1996). Results show a hit rate of 100% for each group. Findings reveal that adequate Trial 1 scores predict adequate Trial 2 and Retention Trial scores, suggesting that patients scoring 45 or greater on Trial 1 are not likely to be suspected of poor effort based on overall TOMM performance.

Utility of the Trail Making Test in the Assessment of Malingering in a Sample of Mild Traumatic Brain Injury Litigants

The Trail Making Test (TMT) is one of the most commonly administered tests in neuropsychological assessments. It has been shown to be a valid indicator of brain damage due to traumatic brain injury (TBI), as well as a number of other neuropathological conditions. TMT error and ratio scores have been suggested as possible markers of malingering. The present study examined the utility of various TMT scores as malingering measures in 94 TBI litigants. Litigants were divided into those suspected of (n =27) and those not suspected of malingering (n =67) based on scores obtained on the Test of Memory Malingering and/or the Rey 15-Item Test. TMT errors did not discriminate between suspected and nonsuspected malingerers; however, the overall level of performance on the TMT was suppressed in suspected malingerers. The TMT ratio score was significantly lower in litigants suspected of malingering, although the clinical utility of this ratio is minimal. Results of the present study suggest using caution when interpreting TMT scores as markers of malingering in TBI litigants.

Presence of third parties during neuropsychological evaluations: Who is evaluating whom?

Abstract State and federal laws and court decisions that address requests for the presence or absence of third party observers during forensic evaluations are reviewed, as are the legal arguments for both their inclusion and exclusion. Potential sources of interference created by observers presence during the neuropsychological evaluation are outlined with reference to the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association, the Specialty Guidelines for Forensic Psychologists: Committee on Ethical Guidelines for Forensic Psychologists, and the Standards for Educational and Psychological Testing. The relevant empirical literature dealing with the phenomenon of social facilitation is also presented. Guidelines are offered for use by the neuropsychologist who receives a request for observation by a third party.

Screening for neuropsychological impairment using Reitan and Wolfson's preliminary neuropsychological test battery ☆

This study examined the utility of a screening battery developed by Reitan & Wolfson, 2006 for predicting neuropsychological impairment on the Halstead-Reitan neuropsychological test battery for adults. Using archival neuropsychological data from 69 litigants seen in a private practice setting, the Pearson correlation between the General Neuropsychological Deficit Scale (GNDS) score and the total Neuropsychological Deficit Scale (NDS) score from the screening battery (SBNDS) was .82. ROC curve analysis determined that the AUC was .88. Using a cutoff score of 9, as recommended by Reitan and Wolfson, the screening battery had excellent specificity but only fair sensitivity for identifying individuals with neuropsychological impairment on the Halstead-Reitan battery. Using a cutoff score of 8, the sensitivity and specificity of the screening battery was comparable to the findings of Reitan and Wolfson. The findings from this study indicate the optimal cutoff score for the screening battery may vary with different populations. The positive predictive power (PPP) and negative predictive power (NPP) were calculated for various base rates for cut scores with both sensitivity and specificity of greater than .600, and this information is provided.