Five validation experiments of the Test of Memory Malingering (TOMM).

Abstract

Malingering (TOMM; T. N. Tombaugh, 1996) is a newly developed visual recognition test that uses pictures of common objects as stimuli. Prior normative research with community-dwelling adults and neurologically impaired patients has shown that the TOMM possesses a high degree of specificity and is not affected by demographic variables such as age and education. The current series of 5 integrated experiments was designed to provide important validation data. Converging evidence from all studies showed that scores on the TOMM are able to detect when an individual is not putting forth maximum effort. Overall, the TOMM's high levels of sensitivity and specificity suggest that it has high promise as a clinical test for detecting malingering of memory impairments. Recent interest in the detection of malingering, the intentional faking or exaggeration of symptoms for personal gain, has generated a consistent body of evidence showing that recognition procedures are particularly sensitive in detecting someone feigning memory impairment during neuropsychological assessment. Much of this evidence stems from a procedure commonly referred to as symptom validity testing (SVT). This is a twoitem, forced-choice recognition paradigm originally used for the detection of sensory impairments (Brady & Lind, 1961; Grosz & Zimmerman, 1965) and later modified to determine malingering of cognitive deficits (Pankratz, 1979; Pankratz, Fausti, & Peed, 1975). More recently, SVT has further been developed by Hiscock and Hiscock (1989) and Binder and Willis (1991). The most popular variation of this procedure contains a series of trials where a five-digit number is presented on each trial and is followed by a delay interval and a two-choice test trial containing the original number and a novel five-digit number. Although this procedure has demonstrated clinical util

Detection of inadequate effort on the California Verbal Learning Test-Second edition: Forced choice recognition and critical item analysis

“…As such, values, interpretation, and discussion of the CVLT-II FCR and CIA indices is qualified and limited by the gold standard measures to which they are compared. With regard to sensitivity and specificity values for the TOMM, previous studies indicate sensitivity rates ranging between 77% and 100% in simulation studies of malingering, with corresponding specificity rates all at 100% (Rees et al, 1998;Tombaugh, 1996Tombaugh, , 1997. With regard to sensitivity and specificity of the VIP, the original validation study indicates sensitivity rates of the Verbal subtest at 67%, the Nonverbal subtest at 74%, either subtest at 78%, and both subtests at 63%; corresponding specificity rates were 83% for the VIP Verbal subtest, 86% for the Nonverbal subtest, 78% for either subtest, and 93% for both subtests (Frederick, 1997).…”

“…As discussed previously, any comparison between a gold standard measure and a candidate measure will be limited by the ultimate sensitivity and specificity values of the gold standard. Although both the TOMM and VIP have acceptable sensitivity and specificity values, a subset of individuals exhibiting inadequate effort are missed by both measures in previous studies (Frederick, 1997;Rees et al, 1998;Tombaugh, 1996Tombaugh, , 1997. Other measures, such as the Word Memory Test (Green et al, 1996), may offer increased agreement with the FCR and CIA, due to reported higher sensitivity rates (Gervais et al, 2004).…”

Call for an Integrative and Multi-Disciplinary Approach to Traumatic Brain Injury (TBI)

“…Using a criterion cutoff score of 45 on Trial 2, TOMM had specificity rates of greater than 90% (Rees, Tombaugh, Gansler, & Moczynski, 1998;Tombaugh, 1996) a,c…”

Test of Memory Malingering (TOMM): Normative data for the Latin American Spanish speaking adult population

“…In general, the neurocognitive literature explains that the features of the TOMM are insensitive to the effects of neurocognitive impairment (Tombaugh, 1997). There is also evidence for the specificity of the TOMM for individuals who have sustained traumatic brain injuries, in which the effects of the injury did not increase false positive results (Rees et al, 1998). Despite the TOMM's insensitivity to the effects of neurocognitive impairment, there is evidence to caution clinicians to rule out dementia diagnoses in order to prevent misclassification of malingering (Teichner & Wagner, 2004).…”

“…Although the retention trial, a delayed, non-forced choice memory task, has been reported to be optional (Tombaugh & Tombaugh, 1996), research has indicated that, unless a comparable symptom validity test is also administered in the battery, the retention trial must be administered for greater accuracy (Greve & Bianchini, 2006). Examination of the instrument has demonstrated that a criterion cutoff score of 45 on Trial 2 provided 95% accuracy of identifying non-malingering patients without dementia, and specificity of 91% with all patients (Rees, Tombaugh, Gansler, & Moczynski, 1998;Tombaugh, 1997;Tombaugh & Tombaugh, 1996).…”