Assessing Effort During Neuropsychological Evaluation with the TOMM in Children and Adolescents with Epilepsy

Abstract

Effort assessment is of particular importance in pediatric epilepsy where neuropsychological findings may influence treatment decisions, especially if surgical interventions are being considered. The present investigation examines the Test of Memory Malingering (TOMM) in 60 children and adolescents with epilepsy. The overall pass rate for the sample was 90%. TOMM scores were unrelated to age, though there was a significant correlation between TOMM Trial 2 scores and intelligence estimates. Overall, the TOMM appears to be a valid measure of effort in young epilepsy patients, though caution should be used when interpreting scores for those with very low IQ, especially if behavioral problems are also evident. Caution should also be exercised in interpreting scores in children with ongoing interictal epileptiform activity that may disrupt attention.

Performance on the Test of Memory Malingering (TOMM) among a large clinic-referred pediatric sample

“…Despite the fact that the vast majority of children can pass the TOMM, there were statistically significant correlations between all TOMM trials and age, grade, intelligence, and memory. The current study correlations are similar to those found by MacAllister et al (2009), who documented a significant relationship between IQ and TOMM performance for Trials 1 and 2 and those found by Donders (2005), who documented a significant relationship between age and TOMM performance for Trials 1 and 2. In contrast to Donders (2005), we found a statistically significant relationship between CVLT-C memory performance and Trial 2 of the TOMM.…”

“…To date, there have been relatively few studies investigating the use of the TOMM in pediatric clinical populations, with the current literature supporting the use of the TOMM in patient populations as young as 6 years of age (Donders, 2005;MacAllister et al, 2009) and as a young as 5 years of age among typically developing children (Constantinou & McCaffrey, 2003). The current study revealed similar findings, suggesting that the TOMM is appropriate for use with pediatric clinical populations.…”

Noncredible Effort during Pediatric Neuropsychological Exam: A Case Series and Literature Review

“…Regardless of whether a provider has a complete understanding of why a child fails an SVT, such performance should raise questions about the validity of all collected data, particularly if there is not evidence for genuine, significant impairment that could reasonably account for the results (MacAllister et al, 2009). As has been discussed in the adult literature, SVT failure cannot be equated with malingering.…”

“…When Donders (2005) examined the performance of 100 general pediatric patients on the Test of Memory Malingering (TOMM), he found two boys with a history of noncompliant behavior who were thought to be putting forth insufficient effort. MacAllister, Nakhutina, Bender, Karantzoulis, and Carlson (2009) reported that 2 out of 60 pediatric epilepsy patients performed poorly on the TOMM because of effort-related problems, rather than seizure-related impairment. Similarly, in a study by Carone (2008) Higher rates of response bias have been found in two additional pediatric case series, one of which included a population with a clear external incentive to perform poorly and one of which did not.…”

“…Children down to age 5 years can pass the TOMM (Constantinou & McCaffrey, 2003;Donders, 2005;MacAllister et al, 2009;Nagle, Everhart, Durham, McCammon, & Walker, 2006). The Word Memory Test (WMT) and Computerized Assessment of Response Bias (CARB) require some facility with reading and numbers, so they are inappropriate for early elementary-aged children; however, on the primary effort indices, children who are at least 11 years old score above adult cutoffs (Courtney, Dinkins, Allen, & Kuroski, 2003).…”