A survey of neuropsychologists’ beliefs and practices with respect to the assessment of effort

Abstract

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.

Potential for Bias in MMPI-2 Assessments Using the Fake Bad Scale (FBS)

“…In addition to the lack of consensus regarding optimal cut-off raw scores, studies are quite variable in terms of the base rates of malingering in their samples; as examples, it was 100% in Larrabee (1998) and ranged from 25 to 50% in the table for positive predictive power of the FBS presented in Greiffenstein et al (2004), with their suggestion that 50% is common in worker's compensation settings. These high rates are not unusual in FBS studies, yet are well above the 1 to 20% base rate for malingering reported by Sharland and Gfeller (2007) in their survey of practitioners. How well these high FBS base rates for malingering apply across most settings that use the MMPI-2 is questionable, at best, including those involving psychological injury.…”

“…A survey by Sharland and Gfeller (2007) suggested that the FBS was among the top five most frequently used measures of effort or response bias used by doctoral level members of the National Academy of Neuropsychology (NAN), although their small sample (n=188) and low response rate of 26% precludes generalizability. Furthermore, their conclusions that 75% of those responding used the FBS are offset by the data presented in their tables (i.e., only 43.2% actually reported using the FBS "often" or "always").…”

Deterring malingered psychopathology: The effect of warning simulating malingerers

“…Whilst such practice is recommended (Iverson, 2006) and North American surveys suggest that between one-quarter (Slick et al, 2004) and one-third (Sharland & Gfeller, 2007) of clinicians already ''often or always'' use warnings prior to testing, the effect of warnings on genuine clients must be considered. The present study did not address this issue; however, in previous work we have shown that warnings do not alter the performance of participants who are trying to perform at the best of their ability, at least when memory tests are used (Sullivan, Keane, & Deffenti, 2002).…”

A Survey of Neuropsychologists' Practices and Perspectives Regarding the Assessment of Judgment Ability

“…In terms of basic test usage, researchers have reported on the most commonly used instruments (Butler, Retzlaff, & Vanderploeg, 1991;Camara, Nathan, & Puente, 2000;Rabin et al, 2005), as well as those utilized for specific purposes such as forensic evaluations (Lees-Haley et al, 1996) or within the broad cognitive areas (i.e., memory, attention, executive functioning; Rabin et al, 2005). Recent surveys by Slick et al (2004) and Sharland and Gfeller (2007) have focused on measures used to assess effort, malingering, and/or response bias. Thus, a development in neuropsychological survey work appears to be the identification of instruments used within specific cognitive and/or functional domains.…”