The current study investigated neuropsychologists' beliefs and practices with respect to assessing effort and malingering by surveying a sample of NAN professional members and fellows (n=712). The results from 188 (26.4%) returned surveys indicated that 57% of respondents frequently included measures of effort when conducting a neuropsychological evaluation. While a majority of respondents (52%) rarely or never provide a warning that effort indicators will be administered, 27% of respondents often or always provide such a warning. The five most frequently used measures of effort or response bias were the Test of Memory Malingering (TOMM), MMPI-2 F-K ratio, MMPI-2 FBS, Rey 15-item test, and the California Verbal Learning Test. However, the TOMM, Validity Indicator Profile, Word Memory Test, Victoria Symptom Validity Test, and the Computerized Assessment of Response Bias were rated as most accurate for detecting suboptimal effort. These results and other findings are presented and discussed.

The ability of the Test of Memory Malingering (TOMM; Tombaugh, 1996) to detect feigned-memory impairment was explored. The TOMM was administered to three groups: (a) a control group instructed to perform optimally, (b) a symptom-coached group instructed to feign memory problems after being educated about traumatic brain injury symptomatology, and (c) a test-coached group instructed to feign memory problems after being educated about test-taking strategies to avoid detection. The recommended cutoff scores (Tombaugh, 1996) on Trial 2 and the Retention Trial produced overall classification accuracy rates of 96%, with high levels of sensitivity and specificity. Although the symptom-coached group performed more poorly on the TOMM relative to the test-coached group, the test was equally sensitive in detecting suboptimal effort across the different coaching paradigms.

Overall, these findings corroborate previous findings, extending them to a large clinical sample. BTA and CPT-II are useful embedded performance validity indicators within a clinical battery but should not be used in isolation without other performance validity indicators.