Tests to eval malingering Flashcards
Reliable digit span
longest forward span passed on both trials added to longest backward span passed on both trials
-equal to or less than 7 suggestive of malingering
The last measure of the CVL2 - effort
that’s all
The forced-choice condition of the CVLT-II is an example of an embedded PVT. Following learning, recall, and recognition trials involving a 16-item word list, the test-taker is presented with pairs of words and asked to identify which one was on the list. More than 92 percent of the normative population, including individuals in their eighties, scored 100 percent on this test. Scores below the published cut-off are unusually low and indicative of potential noncredible performance.
Performance Validity Tests (PVT)
- Word Memory Test (WMT)
- Medical Symptom Validity Test (MSVT)
- Non-verbal Medical Symptom Validity Test (NVMSVT)
- Test of Memory Malingering (TOMM)
What is the relationship between failure on a PVT and malingering?
PVT is a measure that was developed specifically to assess effort or consistency of responses. PVTs should be administered over the course of the evaluation because performance validity may wax and wane with increasing and decreasing fatigue, pain, motivation, or other factors that can influence effortful performance PVT “failure” does not equate to malingering or lack of disability. However, clear PVT failures make the validity a neuro test questionable; therefore, no definitive conclusions can be drawn regarding cognitive ability (aside from interpreting normal performances as reflecting normal cognitive ability). An individual who fails PVTs may still have other evidence of disability that can be considered in making a determination; in these cases, further information would be needed to establish the case for disability.
Types of evidence of malingering:
- Circumstances (incentives)
- Evidence from NP tests
- Self-report
Evidence of malingering from NP tests
- Inconsistency in NP test scores
- Reliable digit span
- Vocabulary-digit span difference
- Impaired and unimpaired performance on tests requiring similar cognitive abilities
- Patterns that are not consistent with neuropsychological functioning
Evidence of malingering from self-report
- NP test performance inconsistent with pt’s report of everyday cognitive functioning
- Pt reports everyday cognitive impairment inconsistent with objective facts of injury
- Pt reports everyday cognitive impairment discrepant with other indicators
“Below chance is a good chance of malingering” -Dr. D
PVTs are forced-choice measures on which performance significantly below chance has been suggested to be evidence of intentionally poor performance.
For example, if there are two choices, it would be expected that purely random guessing would result in 50 percent of items correct. Scores deviating from 50 percent in either direction indicate nonchance-level performance. The most probable explanation for substantially below-chance PVT scores is that the test-taker knew the correct answer but purposely selected the wrong answer.
Criteria for definitive malingered neurocognitive dysfunction (MND)
- Presence of substantial external incentive
- Definitive negative response bias (e.g., less than chance performance on forced-choice test [performance validity test])
- Behavior that meets criteria for negative response bias not accounted for by psych, neuro, or development factors
- 2 or more types of evidence from NP testing, or one type of evidence from NP testing, and one or more types of evidence from self-report
- bx that meets np testing criteria and self-report not accounted for by psych, neuro, or dv factors
Identifying likelihood of malingering steps
- admin multiple PVT
- determine the number of “failed” PVT
- calculate the probability of malingering based in the sensitivity and specificity of each test
