Lecture 8 - Effort, response bias, symptom validity

Question 1

What term describes the result of an individual’s attempt to create a specific impression, whether positive or negative?

Answer 1

Response bias

Question 2

TRUE or FALSE

Malingering is a formal psychiatric condition

Answer 2

FALSE

It’s more a medico-legal category

Question 3

When testing for malingering, do we focus on sensitivity or specificity?

Answer 3

Specificity

Because we would rather have a false negative than a false positive

Question 4

What THREE classifications did Slick, Sherman & Iverson (1999) propose for suspected malingerers?

D - P - P

“The Slick Criteria”

Answer 4

1. Definite
2. Probable
3. Possible

Question 5

What are the THREE criteria for classifying someone as “definite” malingering

EI - NRB - PND

Answer 5

1. Presence of substantial EXTERNAL INCENTIVE
2. Definite NEGATIVE RESPONSE BIAS
3. The response bias is not accounted for PSYCHIATRIC, NEUROLOGICAL, DEVELOPMENTAL factors

Question 6

Is the REY 15 a SVT or a PVT?

And is it stand alone

Answer 6

The REY-15 is a stand alone PVT

Question 7

What is the cut score of the REY-15?

And what is the associated specificity and sensitivity?

Answer 7

Cut score: <9

Specificity: 90%

Sensitivity: 36%

Question 8

TRUE or FALSE

The REY-15 is favoured because it is so accurate

Answer 8

FALSE

It is not that accurate. It’s old, not that reliable. It relies on vision and writing.

It’s favoured because it’s quick.

Question 9

What is the minimum SPECIFICITY recommended for malingering tests?

Answer 9

90%

Question 10

What is the TOMM?

Answer 10

The Test of Memory Malingering (TOMM) is a “forced choice” memory paradigm that uses two trials

Question 11

According to the creators of the TOMM, what cut score should you use on the second trial?

Answer 11

<45

Question 12

How are malingering tests validated?

Answer 12

Simulated data, and also people who have not even seen the stimulus

Question 13

What test is considered the gold standard for malingering?

Answer 13

The Test of Memory Malingering (TOMM)

Question 14

According to a meta analysis of the TOMM (Schroeder etc al, 2020), what cut score should you use on the second trial?

Answer 14

49

with the relevant PPV and NPV depending on the base rates

Question 15

What is the estimated base rate for malingering in relation to civil claims TAC claims

Answer 15

40%-50%

For criminal is estimated as 50% or above

Question 16

TRUE or FALSE

The TOMM is so well supported that it alone can be relied on to determine malingering

Answer 16

FALSE

You never rely on just one test

Question 17

What PVT test is published by Weschler?

Answer 17

Word Choices (as part of the Advanced Clinical Solutions package)

Question 18

How do you calculate the Diagnostic odds ratio (DOR)

Answer 18

Ratio of the LR+ and the LR-

DOR = LR+ / LR-

Question 19

Do you want the DOR to be high or low

Answer 19

High

This means the test is performing quite well

Question 20

TRUE or FALSE

To understand the DOR you need to know base rates

Answer 20

FALSE

It is independent of base rates

Question 21

What does Charles’ meta analysis say about the best cut score for the Word Choices test?

Answer 21

42

Question 22

What effort tests are embedded in the WAIS-V/WMS-V

RDS - LMR - VPAR - VRR

Answer 22

1. Reliable digit span
2. Logical Memory II Recognition
3. Verbal Paired Associated II Recognition
4. Visual Reproduction II Recognition

Question 23

What is the recommended cut off for Reliable Digit Span, when assessing effort?

Answer 23

<7 (which is the normative 10% cut off I think)

Question 24

This question is about the multivariate base rates of people who meet the 10% cut off for the effort tests embedded in the WAIS/WMS.

What are the only TWO groups that we would expect to have THREE scores at the 10% cut off?

Answer 24

1. Simulators
2. ID

Question 25

TRUE or FALSE

Multivariate base rate of effort test failure is positively correlated with education level

Answer 25

FALSE

More education means less likely to fail effort tests

Question 26

What are TWO things that could explain lower scores on effort tests that actually have nothing to do with effort?

Answer 26

1. ID
2. Lower education

Question 27

TRUE or FALSE

You should see the results of an assessment before finalising a cut score for effort testing

Answer 27

FALSE

Make decisions about cut off scores before the assessment

Question 29

In the PAI, what is the T score cut off for “clinically elevated” on any given index?

And how many SDs above the mean is that?

Is this for the general population or a psychiatric population?

Answer 29

Cut score = 70

Which is 2 SD above the mean

And this is for the general population. The 70 cut off for psychiatric population defines the “skyline” on the chart.