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Evaluating malingering in cognitive and memory examinations: a guide for clinicians

  • Derek K. Tracy

Summary

Cognitive and memory testing are a common part of clinical practice, but professional concerns are sometimes raised that the individual being tested might be feigning deficits. Most clinicians have limited experience and training in detecting malingering in such cognitive testing, and the very issue raises considerable ethical dilemmas. Nevertheless, psychiatric work faces ever greater potential for legal scrutiny, and failure to appropriately evaluate potential malingering risks professional embarrassment and distress. There is a need for clinicians to make themselves aware of the ways in which malingered behaviour might be evaluated through the clinical history, the use of routine psychometric testing and, particularly, the use of symptom validity (‘malingering’) tests. This article describes these factors and gives guidance on the appropriate reporting of findings.

Learning Objectives

  1. Better understand the complexities in cognitive assessment where malingering is suspected.
  2. Understand the types and limitations of the major symptom validity tests.
  3. Be better prepared to produce documentation and reports stating test findings.

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Copyright

Corresponding author

Dr Derek Tracy, Green Parks House, Princess Royal University Hospital, Orpington, Kent BR6 8NY, UK. Email: derek.tracy@oxleas.nhs.uk

Footnotes

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Declaration of Interest

None.

Footnotes

References

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American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) (DSM-5). APA.
Bass, C, Halligan, P (2014) Factitious disorders and malingering: challenges for clinical assessment and management. Lancet, 383: 1422–32.
Binder, LM (1993) Assessment of malingering after mild head trauma with the Portland Digit Recognition Test. Journal of Clinical and Experimental Neuropsychology, 15: 170–82.
Boone, KB, Lu, P, Back, C et al (2002) Sensitivity and specificity of the Rey Dot Counting Test in patients with suspect effort and various clinical samples. Archives of Clinical Neuropsychology, 17: 625–42.
Bush, SS, Ruff, RM, Troster, AI et al (2005) Symptom validity assessment: practice issues and medical necessity NAN Policy & Planning Committee. Archives of Clinical Neuropsychology, 20: 419–26.
Butcher, JN, Graham, JR, Ben-Porath, YS et al (2001) Minnesota Multiphasic Inventory-2: Manual for Administration, Scoring and Interpretation (Revised Edition). University of Minnesota Press.
Chafetz, M, Underhill, J (2013) Estimated costs of malingered disability. Archives of Clinical Neuropsychology, 28: 633–9.
Cripe, LI (2002) Malady versus malingering: a tricky endeavor. In Functional Disorders (eds Zasler, ND, Martelli, MF) 95112. Hanley and Belfus.
Essig, SM, Mittenberg, W, Petersen, RS et al (2001) Practices in forensic neuropsychology: perspectives of neuropsychologists and trial attorneys. Archives of Clinical Neuropsychology, 16: 271–91.
Green, P, Allen, LM, Astner, K (1996) The Word Memory Test: A User's Guide to the Oral and Computer Administered Forms. Cognisyst Inc.
Greve, KW, Binder, LM, Bianchini, KJ (2009) Rates of below-chance performance in forced-choice symptom validity tests. Clinical Neuropsychologist, 23: 534–44.
Hartman, DE (2002) The unexamined lie is a lie worth fibbing: neuropsychological malingering and the Word Memory Test. Archives of Clinical Neuropsychology, 17: 709–14.
Heilbronner, RL, Sweet, JJ, Morgan, JE et al (2009) American Academy of Clinical Neuropsychology Consensus Conference Statement on the neuropsychological assessment of effort, response bias, and malingering. Clinical Neuropsychologist, 23: 1093–129.
Hiscock, M, Hiscock, CK (1989) Refining the forced-choice method for the detection of malingering. Journal of Clinical and Experimental Neuropsychology, 11: 967–74.
Iverson, GL (2003) Detecting malingering in civil forensic evaluations. In Handbook of Forensic Neuropsychology (eds Horton, AM, Hartlage, LC) 137–79. Springer Publishing Company.
Iverson, GL, Franzen, MD, McCracken, LM (1991) Evaluation of an objective assessment technique for the detection of malingered memory deficits. Law and Human Behavior, 15: 667–76.
Jelicic, M, Ceunen, E, Peters, MJ et al (2011) Detecting coached feigning using the Test of Memory Malingering (TOMM) and the Structured Inventory of Malingered Symptomatology (SIMS). Journal of Clinical Psychology, 67: 850–5.
Kapur, N (1994) The coin-in-the-hand test: a new ‘bed-side’ test for the detection of malingering in patients with suspected memory disorder. Journal of Neurology, Neurosurgery and Psychiatry, 57: 385–6.
Larrabee, GJ (2003) Detection of malingering using atypical performance patterns on standard neuropsychological tests. Clinical Neuropsychologist, 17: 410–25.
Lees-Haley, PR (1997) Attorneys influence expert evidence in forensic psychological and neuropsychological cases. Assessment, 4: 321–4.
Lipman, FD (1962) Malingering in personal injury cases. Temple Law Quarterly, 35: 141–62.
Love, CM, Glassmire, DM, Zanolini, SJ et al (2014) Specificity and false positive rates of the Test of Memory Malingering, Rey 15-Item Test, and Rey Word Recognition Test among forensic inpatients with intellectual disabilities. Assessment, 26 Mar, doi: 10.1177/1073191114528028.
Miller, H, Cartlidge, N (1972) Simulation and malingering after injuries to the brain and spinal cord. Lancet, 1: 580–5.
Mittenberg, W, Patton, C, Canyock, EM et al (2002) Base rates of malingering and symptom exaggeration. Journal of Clinical and Experimental Neuropsychology, 24: 1094–102.
Morel, KR (2009) Test security in medicolegal cases: proposed guidelines for attorneys utilizing neuropsychology practice. Archives of Clinical Neuropsychology, 24: 635–46.
Morgan, JE, Sweet, JJ (eds) (2009) Neuropsychology of Malingering Casebook. Psychology Press.
Nelson, NW, Boone, KB, Dueck, A et al (2003) Relationship between eight measures of suspect effort. Clinical Psychologist, 17: 263–72.
Prigatano, GP, Amin, K (1993) Digit Memory Test: unequivocal cerebral dysfunction and suspected malingering. Journal of Clinical and Experimental Neuropsychology, 15: 537–46.
Rees, LM, Tombaugh, TN, Gansler, DA et al (1998) Five validation experiments of the Test of Memory Malingering (TOMM). Psychological Assessment, 10: 1020.
Reitan, RM, Wolfson, D (1993) The Halstead–Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation (2nd edn). Neuropsychology Press.
Reitan, RM, Wolfson, D (1997) Consistency of neuropsychological test scores of head-injured subjects involved in litigation compared with head-injured subjects not involved in litigation: development of the Retest Consistency Index. Clinical Psychologist, 17: 6976.
Rey, A (1964) L'Examen Clinique en Psychologie [Clinical Tests in Psychology ]. Presses Universitaires de France.
Schroeder, RW, Buddin, WH Jr, Hargrave, DD et al (2013) Efficacy of Test of Memory Malingering Trial 1, Trial 2, the Retention Trial, and the Albany Consistency Index in a criterion group forensic neuropsychological sample. Archives of Clinical Neuropsychology, 28: 21–9.
Sharland, MJ, Gfeller, JD (2007) A survey of neuropsychologists' beliefs and practices with respect to the assessment of effort. Archives of Clinical Neuropsychology, 22: 213–23.
Slick, DJ, Sherman, EM, Iverson, GL (1999) Diagnostic criteria for malingered neurocognitive dysfunction: proposed standards for clinical practice and research. Clinical Neuropsychologist, 13: 545–61.
Slick, DJ, Tan, JE, Strauss, EH et al (2004) Detecting malingering: a survey of experts' practices. Archives of Clinical Neuropsychology, 19: 465–73.
Teichner, G, Wagner, MT (2004) The Test of Memory Malingering (TOMM): normative data from cognitively intact, cognitively impaired, and elderly patients with dementia. Archives of Clinical Neuropsychology, 19: 455–64.
Tombaugh, TN (1996) The Test of Memory Malingering. Multi-Health Systems.
Victor, TL, Abeles, N (2004) Coaching clients to take psychological and neuropsychological tests: a clash of ethical obligations. Professional Psychology: Research and Practice, 35: 373–9.
Wechsler, D (1997) Wechsler Adult Intelligence Scale III. Psychological Corporation.
World Health Organization (1992) The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. WHO.

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Evaluating malingering in cognitive and memory examinations: a guide for clinicians

  • Derek K. Tracy
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