Robert L. Heilbronner

American Academy of Clinical Neuropsychology Consensus Conference Statement on the Neuropsychological Assessment of Effort, Response Bias, and Malingering

During the past two decades clinical and research efforts have led to increasingly sophisticated and effective methods and instruments designed to detect exaggeration or fabrication of neuropsychological dysfunction, as well as somatic and psychological symptom complaints. A vast literature based on relevant research has emerged and substantial portions of professional meetings attended by clinical neuropsychologists have addressed topics related to malingering (Sweet, King, Malina, Bergman, & Simmons, 2002). Yet, despite these extensive activities, understanding the need for methods of detecting problematic effort and response bias and addressing the presence or absence of malingering has proven challenging for practitioners. A consensus conference, comprised of national and international experts in clinical neuropsychology, was held at the 2008 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN) for the purposes of refinement of critical issues in this area. This consensus statement documents the current state of knowledge and recommendations of expert clinical neuropsychologists and is intended to assist clinicians and researchers with regard to the neuropsychological assessment of effort, response bias, and malingering.

Further Validation of the MMPI-2 and MMPI-2-RF Response Bias Scale: Findings From Disability and Criminal Forensic Settings

The present study extends the validation of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Response Bias Scale (RBS; R. O. Gervais, Y. S. Ben-Porath, D. B. Wygant, & P. Green, 2007) in separate forensic samples composed of disability claimants and criminal defendants. Using cognitive symptom validity tests as response bias indicators, the RBS exhibited large effect sizes (Cohens ds = 1.24 and 1.48) in detecting cognitive response bias in the disability and criminal forensic samples, respectively. The scale also added incremental prediction to the traditional MMPI-2 and the MMPI-2-RF overreporting validity scales in the disability sample and exhibited excellent specificity with acceptable sensitivity at cutoffs ranging from 90T to 120T. The results of this study indicate that the RBS can add uniquely to the existing MMPI-2 and MMPI-2-RF validity scales in detecting symptom exaggeration associated with cognitive response bias.

Examination of the MMPI-2 Restructured Form (MMPI-2-RF) Validity Scales in Civil Forensic Settings: Findings from Simulation and Known Group Samples

The current study examined the effectiveness of the MMPI-2 Restructured Form (MMPI-2-RF; Ben-Porath and Tellegen, 2008) over-reporting indicators in civil forensic settings. The MMPI-2-RF includes three revised MMPI-2 over-reporting validity scales and a new scale to detect over-reported somatic complaints. Participants dissimulated medical and neuropsychological complaints in two simulation samples, and a known-groups sample used symptom validity tests as a response bias criterion. Results indicated large effect sizes for the MMPI-2-RF validity scales, including a Cohens d of .90 for Fs in a head injury simulation sample, 2.31 for FBS-r, 2.01 for F-r, and 1.97 for Fs in a medical simulation sample, and 1.45 for FBS-r and 1.30 for F-r in identifying poor effort on SVTs. Classification results indicated good sensitivity and specificity for the scales across the samples. This study indicates that the MMPI-2-RF over-reporting validity scales are effective at detecting symptom over-reporting in civil forensic settings.

Identification of malingered head injury on the Halstead-Reitan battery ☆

Heaton et al. (1978) demonstrated that the performance of malingerers and actual head trauma patients could be distinguished on the HRB by discriminant analysis. The present study replicated Heaton et al.s methodology on a larger sample to provide a more stable function for discriminating simulated and real head trauma. Malingerers (n = 80) were instructed to fake severe deficits without being obvious. Patients (n = 80) had documented trauma and were not litigating for compensation. Groups were matched on age, gender, and overall Impairment Index to permit comparisons between patterns of performance. A crossvalidated step-wise discriminant function correctly identified 88.75% of the groups, with 83.8% true positives and 93.8% true negatives. This function was applied to several published data sets. Both malingerer and patient groups were accurately identified in Heaton et al. (1978) and Trueblood and Schmidt (1993). Faust et al.s (1988) adolescent malingerer and the malingered performance of three litigating patients published by Cullum et al. (1991), were also correctly classified.

Neuropsychological consequences of boxing and recommendations to improve safety: a National Academy of Neuropsychology education paper

Boxing has held appeal for many athletes and audiences for centuries, and injuries have been part of boxing since its inception. Although permanent and irreversible neurologic dysfunction does not occur in the majority of participants, an association has been reported between the number of bouts fought and the development of neurologic, psychiatric, or histopathological signs and symptoms of encephalopathy in boxers. The purpose of this paper is to (i) provide clinical neuropsychologists, other health-care professionals, and the general public with information about the potential neuropsychological consequences of boxing, and (ii) provide recommendations to improve safety standards for those who participate in the sport.

Examination of the new MMPI-2 Response Bias Scale (Gervais): relationship with MMPI-2 validity scales

Validity scales were recently developed to improve assessment of symptom validity beyond original MMPI-2 validity scales. In an initial study, the Response Bias Scale (RBS; Gervais, 2005) was developed based upon non-head-injury claimant performances on a cognitive effort measure, the Word Memory Test (WMT). The present study examined relationships of the RBS with numerous MMPI-2 validity scales in a sample of 211 participants with secondary gain (SG) or no secondary gain (NSG). Of the validity scales observed, RBS yielded the largest effect size difference between groups (d = .65), followed closely by FBS (d = .60) and the L-scale (d = .51). Overall, RBS correlated most significantly (r = .74, p < .001) with FBS, but also showed significant correlations with most other validity scales for both groups. RBS further demonstrated significant correlations (p < .001) with all clinical scales except for Mf. Findings suggest that RBS and FBS may represent a similar construct of symptom validity, and may outperform other MMPI-2 validity scales in discriminating SG and NSG groups. Findings provide preliminary support for use of RBS within the forensic context.

A status report on the practice of forensic neuropsychology.

The practice of forensic neuropsychology has experienced tremendous growth over the past two decades, becoming perhaps the most rapidly expanding area of practice within the field of clinical neuropsychology. Indeed, there have been many important advancements in the field that have helped to position neuropsychologists as instrumental participants within the forensic arena. Yet, there is currently no consensus in our field regarding what constitutes competency in forensic neuropsychology and also no specific guidelines or standards of practice to inform neuropsychologists about how to operate in the forensic arena. There are even fewer safeguards to protect the public from questionable methods of practice. This article provides a status report on the practice of forensic neuropsychology. It employs a framework emphasized byOtto and Heilbrun(2002)in their assessment of the field of forensic psychology. Emphasis is directed toward identifying recent advances in the field and documenting some of the inherent flaws and weaknesses in forensic practice to help advance the practice of forensic neuropsychology toward a more established specialty area.

Comparison of the Lees-Haley Fake Bad Scale, Henry-Heilbronner Index, and Restructured Clinical Scale 1 in Identifying Noncredible Symptom Reporting

A known groups design investigated the comparative predictive validity of the 27-item MMPI-2 Restructured Scale 1 (RC1), the 43-item Lees-Haley Fake Bad Scale (FBS), and the 15-item Henry-Heilbronner Index (HHI) to identify noncredible symptom response sets in 63 personal injury litigants and disability claimants compared to 77 non-litigating head-injured controls. Logistic regression analyses revealed that the HHI and FBS were better predictors of group membership than the RC1. Results suggest that the FBS, HHI, and RC1 may be measuring different constructs. The HHI and FBS reflect an exaggeration of disability or illness-related behavior. Differences in scale construction are discussed. The RC1 may have greater relevance under external incentive conditions involving chronic pain patients, or clinical patients with no external incentive to exaggerate their symptom presentation.

Verbal fluency task equivalence

Abstract The research and clinical use of the verbal fluency paradigm has been hindered by the paucity of information on the equivalency of the various versions of this measure. Currently, the comparability of the two most commonly used forms of the letter fluency task, the “FAS” and “CFL” tests, is uncertain. The equivalence of these versions was investigated by examining their consistency across and within settings and disease processes. The two verbal fluency tasks were administered to 287 patients at two separate sites as part of a neuropsychological evaluation. Results showed that the CFL and FAS verbal fluency paradigms were equivalent across both settings and diagnostic groups with correlations ranging from .87 to .94. These findings may be useful for both researchers and clinicians who require equivalent measures for repeated testing. Furthermore, the demonstrated equivalency of the two paradigms may facilitate interpretation of research findings across laboratories.

Use of MMPI-2 to predict cognitive effort: A hierarchically optimal classification tree analysis

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context.