W. John Baker

MMPI-2 validity scales versus domain specific measures in detection of factitious traumatic brain injury

Abstract A known group methodology was used to compare the predictive accuracies of MMPI-2 validity scales and malingered amnesia measures in the detection of real versus feigned traumatic brain-injury. The domain specific compliance measures were consistently more accurate in the separation of factitious brain-injury patients (n = 68) from severe brain-injury patients (N = 56). Among MMPI-2 measures, only scale Sc improved on base-rate predictions of probable malingering. Anti-social traits, as measured by Pd, had no relationship to malingered amnesia. Factor analysis suggested independent psychiatric and neurological malingering factors. The implications for DSM-IV malingering criteria and models of feigned illness are discussed.

Comparison of Premorbid and Postinjury MMPI-2 Profiles in Late Postconcussion Claimants

A comparison of premorbid and postinjury MMPI-2 profiles was performed in 23 patients with mild cranial/cervical injuries. All claimants attributed major personality change to their injuries during the course of compensation-related neuropsychological examinations. Their premorbid MMPI-2 profiles were all abnormal and the modal code-type indicated somatoform psychopathology. The post-accident MMPI profiles showed continuous somatization trends, but they unexpectedly showed (a) increased defensiveness and (b) a general decrease in global psychopathology. The findings did not support an eggshell plaintiff theory of chronic postconcussive complaints. The view that chronic postconcussive complaints require a wider focus on non-neuropsychological factors is enhanced.

The Fake Bad Scale and MMPI-2 F-family in detection of implausible psychological trauma claims.

We tested the validity of the Lees-Haley Fake Bad Scale (FBS) and the family of MMPI-2 F scales (F-family; F, F(p), and F-K scales) in predicting improbable psychological trauma claims in an applied setting. Litigants reporting implausible symptoms long after minor scares and nonlitigants clinically referred following severe stressors completed the MMPI-2. Both groups were naturally matched on social class. The FBS demonstrated sensitivity, specificity, and positive predictive power in the detection of atypical problems but the F-family showed poor utility. FBS cutting scores derived from logistic regression were applied to a third group made up of litigants with histories of undeniably severe traumas. A substantial number of this third group scored above cutoffs for exaggeration, but this finding is ambiguous. Reasons for the F-familys insensitivity to real-world exaggeration may include using student simulators for validation and content reflective of psychotic simulation. The superiority of the FBS in applied forensic settings could derive from its development in actual litigants and content reflective of nonpsychotic exaggerations. The FBS appears acceptable for use in applied forensic settings where persons seek compensation for nonpsychotic syndromes.

Test of Memory Malingering and Word Memory Test: A new comparison of failure concordance rates

Two commonly used symptom validity tests are the Test of Memory Malingering (TOMM) and Word Memory Test (WMT). After examining TOMM-WMT failure concordance rates, Green [Green, P. (2007). Making comparisons between forced-choice effort tests. In K. B. Boone (Ed.), Assessment of feigned cognitive impairment (pp. 50-77). New York: Guilford] urged widespread adoption of the WMT, arguing the TOMM is insensitive to feigned impairment. But Green (2007) used a skewed concordance method that favored WMT (one TOMM subtest vs. three WMT subtests). In the present study we compare pass/fail agreement rates with different combinations of TOMM and WMT subtests in 473 persons seeking compensation for predominately mild neurological trauma. We replicated Green (2007) using his asymmetrical method, but otherwise we found the WMT and TOMM produce comparable failure rates in samples at-risk for exaggeration with balanced comparison (three TOMM subtests vs. three WMT). Further work is necessary to compare WMT and TOMM specificities, as failure concordance designs establish reliability but are insufficient for proving validity.

Validity Testing in Dually Diagnosed Post-Traumatic Stress Disorder and Mild Closed Head Injury

Prospects for the coexistence of post-traumatic stress syndrome (PTSS) and mild traumatic brain injury (mTBI) rely exclusively on subjective evidence, increasing the risk of response bias in a compensatable social context. Using a priori specificities derived from genuine brain disorder groups, we examined validity failure rates in three domains (symptom, cognitive, motor) in 799 persons reporting persistent subjective disability long after mild neurological injury. Validity tests included the Test of Memory Malingering, MMPI-2 Fake Bad Scale, and Infrequency (F) scales, reliable digit span, and Halstead-Reitan finger tapping. Analyses showed invalidity signs in large excess of actuarial expectations, with rising invalidity risk conditional on post-traumatic complexity; the highest failure rates were produced by the 95 persons reporting both neurogenic amnesia and re-experiencing symptoms. We propose an “over-endorsement continuum” hypothesis: The more complex the post-traumatic presentation after mild neurological injury, the stronger the association with response bias. Late-appearing dual diagnosis is a litigation phenomenon so intertwined with secondary gain as to be a byproduct of it.

Premorbid Clues? Preinjury Scholastic Performance and Present Neuropsychological Functioning in Late Postconcussion Syndrome

Neuropsychologists rely on demographic variables to form assumptions about premorbid status, and most use years of education as the main variable. School records are a more objective basis for such estimation, particularly in litigated cases. In the present study, final cumulative grade point average (GPA) was regressed on to Halstead-Reitan Battery (HRB), IQ and other neuropsychological test scores in 60 nonmalingering postconcussive litigants and 17 litigants with moderate-severe closed head injury. Results indicated significant correlations between GPA, HRB core tests, commonly used neuropsychological measures, and intelligence. A regression formula indicated litigants with poor grade point average were likely to perform in the impaired range. The present findings suggest the quality of premorbid academic performance also provides an important context in which to view present neuropsychological performance. Marginal premorbid achievement may be a risk factor for late developing postconcussion syndrome and litigation.

Symptom Validity Testing in Medically Unexplained Pain: A Chronic Regional Pain Syndrome Type 1 Case Series

This study examines validity findings in a particular behavioral pain disorder. We examined two types of validity scores in 73 participants with a primary diagnosis of the controversial Complex Regional Pain Syndrome Type I (CRPS-1). All participants were incentivized by a disability-seeking context. Failure rates on performance validity tests ranged from 23% (Test of Memory Malingering) to 50% (Reliable Digit Span). Positive findings on symptom validity tests (MMPI-2 or MMPI-2-RF) ranged from 15% to 50% of subsamples. At least 75% of the sample failed one performance validity indicator and over half showed at least one positive symptom validity score. This initial study suggests that CRPS-1 could serve as a good patient model for studying the role of simulation in pain-related disability.

Neuropsychological and psychosocial correlates of adult arithmetic deficiency

The purpose of this study was to examine adult correlates of rule-derived arithmetic deficiency. The authors collected neuropsychological, handedness, gender, and psychosocial data of adults with stringently defined arithmetic deficiency (AD; N = 45), reading deficiency (N = 45), and dual deficiency (N = 45). The authors did not match groups on IQ score and did not restrict analyses to right-handed men. The results indicated that AD in adults is associated with nonverbal reasoning and constructional problems. Otherwise, there was no association between AD and dysphoric complaints as defined by Minnesota Multiphasic Personality Inventory elevations. The authors also found overall intelligence was lower in adults with AD, and gender distribution differed markedly from the reading and dual deficient groups. Potential gender bias in remediation referral patterns was identified.

Brief report: anosmia and remote outcome in closed head injury.

The value of posttraumatic anosmia as a predictor of late social outcomes was examined in a sample of closed head injury (CHI) patients. Unemployment rates were equally high in both the anosmic and nonanosmic closed head injury patients. The groups also did not differ in psychiatric or neuropsychological status. Anosmic patients had longer initial hospital stays and deeper initial comatose/confusional states. Anosmia does not appear to add incrementally to disability status and it does not automatically imply the presence of basal-frontal damage.

Policy Statement of the American Board of Professional Neuropsychology regarding Third Party Observation and the recording of psychological test administration in neuropsychological evaluations

Neuropsychologists are frequently presented with requests from parents, attorneys, nurse case managers, insurance representatives, school personnel, allied health professionals, family members, or other interested parties who have some type of relationship with a patient or client examinee to directly observe or record the administration of psychological and neuropsychological tests. Consequently, a number of practice concerns have been raised that include, but are not limited to, the effects on the examinee’s performance and the neuropsychologist administering the assessment, violations of testing guidelines, the impact on standardization procedures, the appropriateness of applying test findings to normative samples established under standardized circumstances, and test security. These requests can become even more problematic and complicated when the request occurs within the adversarial process associated with the legal system, such as competency hearings, custody evaluations, divorce proceedings, civil litigation, and criminal investigations (Bush, Pimental, Ruff, Iverson, Barth & Broshek, 2009; Duff & Fisher, 2005; Howe & McCaffrey, 2010; Lynch, 2005; McCaffrey, Fisher, Gold, & Lynch, 1996; McCaffrey, Lynch, & Yantz, 2005; McSweeny et al., 1998; Sweet, Grote, & Van Gorp, 2002).