Invited Commentary: Advancing but not yet Advanced: Assessment of Effort/Malingering in Forensic and Clinical Settings.

Abstract

Neuropsychologists' conclusions and courtroom testimony on malingering can have profound impact. Intensive and ingenious research has advanced our capacities to identify both insufficient and sufficient effort and thus make worthy contributions to just conflict resolution. Nevertheless, given multiple converging factors, such as misleadingly high accuracy rates in many studies, practitioners may well develop inflated confidence in methods for evaluating effort/malingering. Considerable research shows that overconfidence often increases diagnostic and predictive error and may lead to fixed conclusions when caution is better advised. Leonhard's work thus performs an important service by alerting us to methodological considerations and shortcomings that can generate misimpressions about the efficacy of effort/malingering assessment. The present commentary covers various additional complicating factors in malingering assessment, including other factors that also inflate confidence; subtle and perhaps underappreciated methodological flaws that are inversely related to positive study outcomes (i.e., the worse the flaws the better methods appear to be); oversimplified classifications schemes for studying and evaluating effort that overlook, for example, common mixed presentations (e.g., malingering and genuinely injured); and the need to expand research across a greater range and severity of neuropsychological conditions and diverse groups. More generally, although endorsing various points that Leonhard raises, a number of questions and concerns are presented, such as methods for calculating the impact of case exclusions in studies. Ultimately, although Leonhard's conclusions may be more negative than is justified, it seems fair to categorize methods for assessing malingering/effort as advancing, but not yet advanced, with much more needed to be done to approach that latter status.