Kevin W. Greve

Symptom Validity Testing: A Critical Review

This paper provides a comprehensive review of the published literature on symptom validity tests (SVT) and, with the accompanying tables, serves as a reference to assist in their selection, interpretation, and defense. Because malingering is inherently an applied problem that frequently arises in a medico-legal context, the use of SVTs must meet certain standards. Thus, a number of methodological and theoretical weaknesses of SVT research which limit the use of SVTs as clinical tools and sources of evidence are highlighted. These criticisms incorporate recommendations which must be addressed if conclusions based on SVT data are to meet the increasingly rigorous standards for the admissibility of scientific evidence.

Impulsiveness and risk-taking behavior: comparison of high-school and college students using the Barratt Impulsiveness Scale

The present study was undertaken in an attempt to determine the relationship of impulsiveness to risk-taking behaviors such as aggression, drug use, drunk driving and not wearing seatbelts among highschool and college students. The results of the study clearly demonstrate that high impulsives are involved in risk-taking behavior at a higher rate than low impulsive subjects. These findings suggest that high impulsive adolescents and young adults are at considerable risk of personal injury and present a potential source of injury to others. It is suggested that self-report questionnaires of impulsiveness might prove useful in the early identification of these high risk individuals. Once identified these individuals could be targeted for intensive educational interventions specifically designed to deal with their inability to delay gratification and general lack of impulse control. Language: en

Detecting Malingering in Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice Symptom Validity Tests

Individual and joint malingering detection accuracy of the Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), and Word Memory Test (WMT) was examined in traumatic brain injury (TBI; 43 non-malingering, 27 malingering) and chronic pain (CP; 42 non-malingering, 58 malingering) using a known-groups design. At published cutoffs, the PDRT and TOMM were very specific but failed to detect about 50% of malingerers; the WMT was sensitive but prone to false positive errors. ROC analyses demonstrated comparable accuracy across all three tests. Joint classification accuracy was superior to that of the individual tests. Clinical and research implications are discussed.

WAIS digit span-based indicators of malingered neurocognitive dysfunction: classification accuracy in traumatic brain injury.

The present study determined specificity and sensitivity to malingered neurocognitive dysfunction (MND) in traumatic brain injury (TBI) for several Wechsler Adult Intelligence Scale (WAIS) Digit Span scores. TBI patients (n = 344) were categorized into one of five groups: no incentive, incentive only, suspect, probable MND, and definite MND. Performance of 1,063 nonincentive patients (e.g., cerebrovascular accident, memory disorder) was also examined. Digit Span scores included reliable digit span, maximum span forward both trials correct, maximum span forward, combined maximum forward and backward span, Digit Span scaled score, maximum span backward both trials correct, and maximum span backward. In TBI, sensitivity to MND ranged from 15% to greater than 30% at specificities of 92% to 98%. Patient groups with documented brain pathology had higher false-positive error rates. These results replicate previous known-groups malingering studies and provide valuable data supporting the WAIS Digit Span scores in detection and diagnosis of malingering.

Detecting Malingered Neurocognitive Dysfunction Using the Reliable Digit Span in Traumatic Brain Injury

This study assessed the effectiveness of Greiffenstein’s Reliable Digit Span (RDS) score for the detection of malingered neurocognitive dysfunction. Participants were 54 traumatic brain injury patients referred for neuropsychological evaluation. Twenty-four met the Slick, Sherman, and Iverson criteria for at least probable malingered neurocognitive dysfunction. The control group was composed of 30 patients without external incentive and who thus did not meet the Slick criteria. All patients completed the digit span test as part of either the WAIS-R or WAIS-III. The RDS scores were calculated, and sensitivity, specificity, and predictive power were examined for several cutoffs. Classification accuracy for the RDS was excellent. Issues related to the clinical application of this technique are discussed.

Assessment of Executive Function in Patients with Mild Traumatic Brain Injury

BACKGROUND The nature of functional deficit after mild traumatic brain injury (TBI) defined by Glasgow Coma Score of 13-15 is not fully described. This study explored the sensitivity of several neuropsychological tests to identify sequelae of mild traumatic brain injury (TBI). METHODS Eleven adult patients with mild TBI admitted to a Level 1 trauma center were studied. The battery of tests included the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Trails A and B, the Boston Naming Test, The Multilingual Aphasia Examination: Controlled Oral Word Association Test, and the Paced Auditory Serial Addition Task. RESULTS Control subjects performed significantly better than patients with mild TBI on Trails A and B, the Controlled Oral Word Association Test, and Paced Auditory Serial Addition Task (subtests 2-4). No significant differences in performances between patients and controls was found for the Wechsler Intelligence Scale for Children -Revised: Mazes Subtest, Boston Naming Test, and Paced Auditory Serial Addition Task Subtest 1. CONCLUSION The results suggest that tests of specific frontal lobe executive functions are valuable in diagnosing and monitoring recovery from mild TBI.

Premeditated aggression: clinical assessment and cognitive psychophysiology

Aggressive behavior has traditionally been classified into two distinct subtypes: an affective, impulsive aggressive display or a planned, predatory aggressive act. While a number of investigations have examined the clinical and physiological correlates in impulsive aggressive individuals, very little research has been conducted on those individuals engaging in predominantly premeditated aggressive acts. The present study compared a group of premeditated aggressive psychiatric outpatients with a group of normal, non-aggressive control subjects on personality, neuropsychological and cognitive psychophysiological measures. Consistent with previous work, premeditated aggressors did not differ significantly from controls on most measures of neuropsychological and psychophysiological function. Premeditated aggressors did show significant personality pathology scoring higher on measures of impulsivity, verbal and physical aggression, anger, hostility, psychoticism and neuroticism. Overall, these results suggest a distinctive personality style that is associated with aggressive behavior. With respect to this and previous work, it is suggested that the physiological aspects of behavioral control play a key role in the type of aggressive behavior displayed.

Classification Accuracy of the Test of Memory Malingering in Traumatic Brain Injury: Results of a Known-Groups Analysis

This study used a known-groups design to determine the classification accuracy of the Test of Memory Malingering (Tombaugh, 1996, 1997) in detecting cognitive malingering in traumatic brain injury (TBI). Forty-one of 161 TBI patients met Slick, Sherman, and Iverson (1999) criteria for Malingered Neurocognitive Dysfunction. Twenty-two no-incentive memory disorder patients were also included. The original cutoffs (<45) for Trial 2 and Retention demonstrated excellent specificity (less than a 5% false positive error rate) and impressive sensitivity (greater than 45%). However, these cutoffs are actually conservative in the context of mild TBI. Over 90% of the non-MND mild TBI sample scored 48 or higher on the Retention Trial and none scored less than 46 while 60% of the MND patients claiming mild TBI were detected at those levels. Trial 1 also demonstrated excellent classification accuracy. Application of these data to clinical practice is discussed.

A comparison of anticonvulsants in the treatment of impulsive aggression.

This study compared the behavioral effects of 3 anticonvulsants in impulsive aggressive men. In a double-blind, placebo-controlled, parallel groups design, participants were randomly assigned to 1 of 4 6-week treatments: phenytoin (n = 7), carbamazepine (n = 7), valproate (n = 7), or placebo (n = 8). The efficacy measure was the average aggression score, a global severity index from the Overt Aggression Scale (J. M. Silver & S. C. Yudofsky, 1991). Analysis showed a significant reduction in impulsive aggression during all 3 anticonvulsant conditions compared with placebo. However, the treatment effect during carbamazepine administration was slightly delayed compared with phenytoin and valproate. These findings suggest that increased use of anticonvulsants could make a significant impact in the control of impulsive aggression in both mental health and criminal justice settings.

Irritability and impulsiveness: relationship to self-reported impulsive aggression

Impulsive aggressive behavior was assessed in a group of 214 college students through self-report. All subjects completed the Anger Attack Questionnaire, Buss-Durkee Hostility Inventory (BDHI) and the Barratt Impulsiveness Questionnaire (BIS-11). Fifty-one subjects (24%) were classified as impulsive aggressive. Analysis of the BDHI and BIS-11 found that impulsive aggressive subjects scored significantly higher than nonaggressives on impulsiveness (BIS-11) and all subscales of the BDHI with the exception of Negativism and Suspicion. Correlation analysis demonstrated that impulsiveness and BDHI Irritability were significantly correlated with number of impulsive aggressive episodes in the previous month, while BDHI Assault was not. Impulsiveness was also found to be significantly related to BDHI Irritability but not to BDHI Assault. Irritability assesses an explosive, uncontrolled type of hostility; assault on the other hand assesses more of a provoked or retaliatory type of hostility which is not likely to be related to impulse control or impulsive aggression. The results of this study clearly demonstrate the usefulness of self-report data in the assessment of impulsive aggressive behavior. BDHI Irritability and BIS-11 impulsiveness both appear to be measuring similar aspects of behavioral control. It is suggested that the BDHI Irritability and BIS-11 scales may be useful in the identification of impulsive aggressive individuals early in their contact with the criminal justice and/or mental health systems.