Detecting feigned traumatic brain injury with eye tracking during a test of performance validity.

Abstract

Objective: Eye-tracking is a promising technology to enhance assessment of performance validity. Research has established that ocular behaviors are reliable biomarkers of (un)conscious cognitive processes, and they have distinguished deceptive from honest responding in experimental paradigms. This study examined the incremental utility of eye-tracking on a clinical performance validity test (PVT) in distinguishing adults with verified TBI from adults coached to feign cognitive impairment. Method: Participants were 49 adults with moderate-to-severe TBI (TBI), 47 healthy adults coached to simulate TBI (SIM), and 67 healthy comparisons providing full effort (HC). A PVT linked to eye-tracking was completed in the context of a full neuropsychological battery. Results: Kruskal-Wallis tests revealed that eye-tracking indices did not differ among the groups during presentation of stimulus items but did differ during forced-choice trials. Compared to TBI and HC, SIM had significantly more transitions, fixations, and time spent looking at correct and incorrect response options. Logistic regressions and ROC curve analyses showed that accuracy was the best predictor of SIM versus HC. For SIM versus TBI, eye-tracking indices exceeded accuracy in distinguishing the groups. Eye-tracking added incremental predictive value to accuracy for both SIM-HC and SIM-TBI discriminations. Conclusion: Eye-tracking indicated that persons feigning TBI showed multiple signs of greater cognitive effort than persons with verified TBI and healthy comparisons. In the comparison of greatest interest (SIM vs. TBI) eye-tracking best predicted group status and yielded excellent discrimination when combined with accuracy. Eye-tracking may be an important complement to traditional accuracy scores on PVTs.

An Eye Tracking Study on Feigned Schizophrenia

“…Their results pointed to strategies used by simulators and cognitive processes that underlie the feigning of cognitive impairments. More recently, Kanser et al (2020) demonstrated that measuring eye behavior may enhance assessment of performance validity. Relying on previous literature on eye movements as reliable biomarkers of unconscious cognitive processes (Barry & Ettenhofer, 2016;Cook et al, 2012;Griffin & Oppenheimer, 2006;Kanser et al, 2017;Vrij et al, 2011), the authors examined the incremental utility of eye behavior on PVTs in discriminating between people who suffered Traumatic Brain Injury (TBI) and people coached to feign cognitive impairment.…”

“…This was found to measure cognitive processes and showed initial promises for the detection of feigned cognitive impairment. Similarly, Kanser et al (2020) examined the incremental utility of eye tracking on a clinical PVT in distinguishing adults diagnosed with TBI from adults coached to feign cognitive impairment. Using eye tracking, the authors found that participants feigning TBI showed multiple signs of greater cognitive effort than both TBI patients and healthy comparisons, and they concluded that eye tracking may be an important complement to traditional accuracy scores on PVTs.…”

Pseudo-Ranks: The Better Way of Ranking?

“…Nonparametric rank-based methods are frequently used particularly in the empirical or life sciences research disciplines (e.g., in psychology; see Kanser et al, 2020, and in medicine; see Han and Jung, 2018;Zimmermann et al, 2019). Basically, there might be at least two reasons for that: On the one hand, the fact that rank-based methods are also applicable to ordinal data renders them useful for analyzing qualityof-life scores, disease severity scales, or more generally, any rating or score of (scientific) interest that satisfies some order relation between its categories.…”

Detecting simulated versus bona fide traumatic brain injury using pupillometry.

“…The inclusion of a clinical group is especially important to the development of new indices designed to detect malingering. Laboratory designs that contrast only healthy adults instructed to be deceptive (TBI simulators) and healthy adults instructed to perform their best often yield results with much larger effects and different patterns than are observed for designs that include the clinical group of interest (Kanser et al, 2020(Kanser et al, , 2019Patrick et al, 2020).…”

“…Biometrics yield psychophysiological markers that provide insight about effort and deception. Success in distinguishing true versus malingered memory test performance in TBI assessment has been demonstrated using biometrics such as reaction time (Kanser et al., 2019; Lupu et al., 2018; Patrick et al., 2020; Rose et al., 1998) and oculomotor gaze patterns during PVTs (Kanser et al., 2020; Tomer et al., 2020). Pupillary reactivity during testing is another promising avenue for investigation in biometrics.…”