Structured Inventory Of Malingered Symptomatology Research Articles

Initial Validation of Short Forms of the SIMS for Neuropsychological Evaluations

The Structured Inventory of Malingered Symptomatology (SIMS) is a measure of impression management that covers a range of symptomatology through 75 items and five scales, some of which are particularly relevant for cognitive evaluations. The aims of the current projects were to (1) reduce the length of the SIMS to the items most predictive of symptom validity on the Minnesota Multiphasic Inventory-2-RF, (2) explore the factor structure of the remaining items, and (3) test the degree to which the final scale identifies individuals with inadequate performance validity. The sample consisted of 249 veterans referred for outpatient neuropsychological assessment and completed the SIMS, most of whom also completed the MMPI-2-RF and measures of performance validity. Results identified items from the Neurological Injury (11 items) and Amnestic Disorders scales (8 items) that were most strongly related to its theoretically consistent MMPI-2-RF scales and that two distinct factors corresponding to the original scales were identified on factor analysis. The revised subscales correlated at r = 0.55, and each scale had acceptable internal consistency (α = 0.76–0.84), and the Amnestic and Total Revised SIMS were adequately able to identify individuals failing measures of performance validity. The reliability and validity of the SIMS for Neuropsychological Settings (SIMS-NS) and its Amnestic subscale, despite its brevity, were practically psychometrically equivalent to the original SIMS and one prior short form of the test.

The Development of a Short Version of the SIMS Using Machine Learning to Detect Feigning in Forensic Assessment

In the present study, we applied machine learning techniques to evaluate whether the Structured Inventory of Malingered Symptomatology (SIMS) can be reduced in length yet maintain accurate discrimination between consistent participants (i.e., presumed truth tellers) and symptom producers. We applied machine learning item selection techniques on data from Mazza et al. (2019c) to identify the minimum number of original SIMS items that could accurately distinguish between consistent participants, symptom accentuators, and symptom producers in real personal injury cases. Subjects were personal injury claimants who had undergone forensic assessment, which is known to incentivize malingering and symptom accentuation. Item selection yielded short versions of the scale with as few as 8 items (to differentiate between consistent participants and symptom producers) and as many as 10 items (to differentiate between consistent and inconsistent participants). The scales had higher classification accuracy than the original SIMS and did not show the bias that was originally reported between false positives and false negatives.

Diagnostic accuracy of the Structured Inventory of Malingered Symptomatology (SIMS) in motor vehicle accident patients

ABSTRACT The SIMS is used in the medico-legal context to assess people who have suffered a traffic accident without proven scientific evidence to support this procedure. The objective of this research is to evaluate the SIMS’ ability to discriminate instructed malingerers, general population, patients who have suffered a traffic accident, and overreporting patients. A simulation design was used to evaluate a total of 650 subjects divided into the four mentioned groups. Our results indicate that the cut-off scores proposed by the authors of the English and Spanish versions (14 and 16) produce moderate sensitivity and specificity values. With a cut-off score of 10, specificity decreases, but sensitivity significantly increases. These results suggest that the SIMS needs to be adapted to the context’s particularities, either by using the proposed cut-off score and other instruments that compensate for the low specificity or by designing new subscales that include symptoms that are typical for the usual conditions in the context.

Descriptive analysis of malingered psychological symptoms in a forensic sample

IntroductionMalingering, defined as a deliberate attempt to lie or deceive in connection with an illness or disability, exaggerating the symptomatology, with the aim of obtaining a personal benefit, is a complex phenomenon, seldom studied in our professional context. The objective of this study was to analyse the way in which this phenomenon manifests itself in the forensic field. Material and methodsAn incidental sample of 190 subjects attended in the Psychology Unit (IMLCFC) over 16 months was selected. The Structured Inventory of Malingered Symptomatology (SIMS) was administered to them, while assessing certain clinical indicators of malingering and other psychometric results. A descriptive statistical analysis of the sample was performed, focusing on the correlations between clinical and psychometric suspicion, and on specific vs. generic test sensitivity. ResultsThe structured clinical criterion to detect malingering correlates moderately with the result obtained in the SIMS; the total score in this test presents a positive, albeit attenuated, correlation with the exaggeration indicators from the main psychopathology test; malingering is a highly prevalent response style in subjects seeking work-related sickness compensation, with a pattern of significantly increased responses compared to that observed in criminal samples. DiscussionThe assessment of malingered psychological symptoms in the forensic context requires a multi-method strategy that includes structured clinical diagnosis, specific detection instruments, and other complementary psychometric tests, in order to generate convergent validity that contributes to the detection of this phenomenon.

A-217 Associations among Symptom Validity Tests in Combat Veterans

Abstract Objective The Neurobehavioral Symptom Inventory (NSI) is a 22-item self-report measure of non-specific cognitive and somatic symptoms, which contains an embedded measure of symptom validity (Validity 10 scale [V-10]). The mild brain injury atypical symptom (mBIAS) is a separate 5-item measure of symptom validity designed for use in mild traumatic brain injury evaluation. The current study evaluated the NSI V-10 and mBIAS in relation to the Structured Inventory of Malingered Symptomatology (SIMS) Total score and subtest scores. Method Participants were 338 veterans who completed a parent study at a VA Medical Center. All participants deployed to Iraq and/or Afghanistan, did not have a history of moderate or severe traumatic brain injury, and did not have significant neurological or psychiatric conditions. Participants completed the SIMS and the NSI with mBIAS as part of a larger battery. The sample was 86% male and 57% White, with a mean age of 42 years and education of 15 years. Results AUC values using a higher SIMS Total cutoff score were .887 for the V-10 and .735 for the mBIAS; diagnostic accuracy data at various cutoff scores are presented. For SIMS subscales, the mBIAS had higher correlations to the Psychosis (r = .48) and Low Intelligence (r = .31) scales, whereas the V-10 had higher correlations to the Neurologic Impairment (r = .73), Amnestic Disorders (r = .66), and Affective Disorders (r = .59) scales. Conclusion Current data suggest that the V-10 and mBIAS measure different symptom validity constructs and could therefore be employed in a complimentary manner.

Relationship between intelligence and posttraumatic stress disorder in veterans

ObjectiveEvaluate the relationships between posttraumatic stress disorder (PTSD) and measures of intelligence in veterans. MethodVeterans (N = 338) who deployed to Iraq and/or Afghanistan were recruited for a VA study on primary blast exposure. PTSD was evaluated using the Clinician Administered PTSD Scale, 5th edition (CAPS-5) and the PTSD Checklist-5. Intelligence was measured using the Wechsler Adult Intelligence Scale, 4th edition and the Test of Premorbid Functioning (TOPF). Validity was assessed with the Medical Symptom Validity Test, b Test, and Structured Inventory of Malingered Symptomatology. Differences in Intelligence Quotient (IQ) estimates between individuals with and without PTSD were evaluated with t-tests. Correlations evaluated associations between symptom burden and intelligence. ResultsOf the seven IQ measures, only the Full Scale IQ score and TOPF Equated scores were significantly lower (but not abnormal) in the lifetime PTSD group. Moreover, these relationships were no longer significant when accounting for multiple comparisons, and symptom/performance validity appeared to better account for those relationships. Current symptom distress was weakly related to several outcomes, but not when using CAPS-5 measures. Neither lifetime nor current PTSD diagnoses were associated with significantly lower IQ scores. ConclusionsThis study did not support prior conclusions that low IQ is a risk factor for developing PTSD. This discrepancy is likely due to the use of ability and symptom validity checks, and sample characteristics (e.g., education). Future research should further evaluate the relationship of symptom distress on intellectual outcomes in combat veteran samples.

Análisis descriptivo de la simulación de síntomas psicológicos en una muestra forense

IntroductionMalingering, defined as a deliberate attempt to lie or deceive in connection with an illness or disability, exaggerating the symptomatology, with the aim of obtaining a personal benefit, is a complex phenomenon, seldom studied in our professional context. The objective of this study was to analyse the way in which this phenomenon manifests itself in the forensic field. Material and methodsAn incidental sample of 190 subjects attended in the Psychology Unit (IMLCFC) over 16 months was selected. The Structured Inventory of Malingered Symptomatology (SIMS) was administered to them, while assessing certain clinical indicators of malingering and other psychometric results. A descriptive statistical analysis of the sample was performed, focusing on the correlations between clinical and psychometric suspicion, and on specific vs. generic test sensitivity. ResultsThe structured clinical criterion to detect malingering correlates moderately with the result obtained in the SIMS; the total score in this test presents a positive, albeit attenuated, correlation with the exaggeration indicators from the main psychopathology test; malingering is a highly prevalent response style in subjects seeking work-related sickness compensation, with a pattern of significantly increased responses compared to that observed in criminal samples. DiscussionThe assessment of malingered psychological symptoms in the forensic context requires a multi-method strategy that includes structured clinical diagnosis, specific detection instruments, and other complementary psychometric tests, in order to generate convergent validity that contributes to the detection of this phenomenon.

Detecting feigned symptoms of depression, anxiety, and ADHD, in college students with the structured inventory of malingered symptomatology

Objective Research consistently shows how easily students can feign symptoms of ADHD on self-report checklists to determine eligibility for curricular and standardized testing accommodations. However, it is unclear how easily students can feign psychological symptoms to accesses academic accommodations, making the assessment of symptom validity important in both populations. Method Using a between-subjects design, 75 college students were randomly assigned to one of three groups: (1) coached feigning of ADHD, (2) coached feigning of depression and anxiety (DA), and (3) honest responding (HR). Participants completed the Depression, Anxiety, and Stress Scale (DASS-21) and the Structured Inventory of Malingered Symptomatology (SIMS). Results The SIMS showed 100% specificity, but low sensitivity (36–52%) for detecting feigned symptoms with different cutoffs. Differences on SIMS subtests were apparent by group with elevated scores for the DA group on the Affective Disorders subscale and elevation for the ADHD group on the Low Intelligence and Amnestic subscales. Participants identified as feigning by the SIMS typically reported more severe symptoms than participants not identified on the DASS-21. Conclusions The SIMS equally classified the feigned ADHD and DA participants for both cutoff scores utilized. Potential reasons for low sensitivity rates are discussed and future research recommendations are made.

Classification accuracy of the rare symptoms and symptom combinations scales of the Structured Inventory of Malingered Symptomatology in three archival samples.

The Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2005) is a 75-item self-report measure intended to screen for potentially feigned symptoms of mental illness and/or cognitive impairment. We investigated the classification accuracy of 2 new detection scales (Rare Symptoms [RS] and Symptom Combinations [SC]) developed by Rogers, Robinson, and Gillard (2014) that appeared useful in identifying simulated mental disorder in their derivation sample of psychiatric inpatients. We hypothesized that the rates of classification accuracy Rogers et al. reported for these 2 scales would generalize to other samples in which the utility of the SIMS previously has been investigated. We computed RS and SC scores from archival SIMS data collected as part of 3 research projects investigating malingering detection methods: (a) general population prison inmates and inmates in a prison psychiatric unit receiving treatment for mental disorder (N = 115), (b) college students (N = 196), and (3) community-dwelling adults (N = 48). Results supported the global classification accuracy of RS and SC but the suggested cut-score for both scales (>6) produced poor sensitivity. Lower potential cut-offs did, however, improve sensitivity to feigning somewhat while not excessively diminishing specificity. These results emphasize the importance of generalizability research when investigating the clinical utility of forensic mental health assessment methods, particularly specific decision rules used to classify individuals into discrete categories. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Meta-analysis ofscale cutoffs in the Structured Inventory ofMalingered Symptomatology

Objective: Using various published data, we estimated the rates of false positives in samples of normal controls when the usual diagnostic cutoffs of the Structured Inventory of Malingered Symptomatology (SIMS) are applied as stipulated in the SIMS manual for all of its 5 scales and for the total score. Method: The original normative data (means and SDs) by Glenn Smith published in SIMS manual for all of its 5 scales and for the total score were used to calculate z scores of each recommended cutoff stipulated in the SIMS manual and thus to estimate, via the assumption of normal distribution, proportions of normal persons that would exceed these cutoffs. The same procedure was then used on meta-analytically combined data from 9 published samples of normal controls. Results: The proportions of 34 normal controls (non-malingerers) in Smith’s original normative sample of presumably healthy undergraduates exceeding the cutoffs for the 5 SIMS scales were 42.1% for the Psychosis (P) scale, 30.9% for Low Intelligence (LI), 29.8% for Amnestic Disorders (AM), 19.8% for the Affective Disorders (AF) scale, and 15.9% for Neurologic Impairment (NI): these persons are misclassified by the cutoffs as “malingerers.” In the meta-analytic sample of controls, the highest proportions of normal controls misdiagnosed as malingerers were 41.7% for Low Intelligence (LI) scale, 28.8% for Psychosis (P), 24.8% for Affective Disorders (AF), 17.9% for Amnestic Disorders (AM), and 15.9% for Neurologic Impairment (NI). The lowest proportions of misdiagnosed normal persons were on the SIMS total score: 4.5% in Smith’s normative sample and 4.6% of persons in the meta-analytically combined sample of 500 normal controls. Conclusion: SIMS cutoffs for its scales misclassify too many normal persons as malingerers. These normal controls were presumably young healthy persons. Since the SIMS items list mainly legitimate medical symptoms (i.e., not items with a reasonable capacity to differentiate legitimate patients from malingerers), the proportions of legitimately injured or otherwise ill persons misclassified as malingerers are likely to be much higher than those reported here for normal controls.

High Risk of False Classification of Injured People as Malingerers by the Structured Inventory of Malingered Symptomatology (SIMS): A Review

High Risk of False Classification of Injured People as Malingerers by the Structured Inventory of Malingered Symptomatology (SIMS): A Review

Ecological Validity of the Inventory of Problems-29 (IOP-29): an Italian Study of Court-Ordered, Psychological Injury Evaluations Using the Structured Inventory of Malingered Symptomatology (SIMS) as Criterion Variable

The Inventory of Problems-29 (IOP-29; Viglione, Giromini, & Landis, Journal of Personality Assessment, 99(5), 534–544, 2017) is a 29-item, recently published, self-administered test aimed at assessing the credibility of various symptom presentations. Although available research strongly supports the use of this symptom validity test in malingering-related contexts, to date, only few studies have analyzed data from real-life forensic evaluations. To fill this gap and explore ecological and convergent validity, the current study analyzed data from 74 court-ordered evaluations aimed at establishing the possible presence of psychological injury. Such evaluations are high-stakes situations in which exaggeration or malingering occur relatively often. We used a research-supported and popular symptom validity test, i.e., the Structured Inventory of Malingered Symptomatology (SIMS; Smith & Burger, Journal of the American Academy on Psychiatry and Law, 25:180–183, 1997), as our criterion variable. The IOP-29 produced excellent area under the curve (AUC) values of .98 with a recommended SIMS total score cutoff (≥ 17) and .99 when eliminating too-close-to-classify cases (Rogers & Bender, 2018) and very large Cohen’s d effect sizes of 2.98 and 3.59, respectively. Crucially, when implementing established cut scores from previous research, the IOP-29 yielded very high specificity and sensitivity rates, and the predictions from the two tests were strikingly similar. Taken together, these findings support the strong convergent validity of the IOP-29 and its utility in applied clinical and forensic settings.

Prevalence of overreporting on symptom validity tests in a large sample of psychosomatic rehabilitation inpatients

Objective: Noncredible symptom claims, regularly expected in forensic contexts, may also occur in clinical and rehabilitation referral contexts. Hidden motives and secondary gain expectations may play a significant role in clinical patients. We studied the prevalence of noncredible symptom report in patients treated for minor mental disorders in an inpatient setting.Method: Five hundred and thirty seven clinical inpatients of a psychosomatic rehabilitation center were studied (mean age: 50.2 years; native speakers of German). They were referred for treatment of depression, anxiety, somatoform disorder, adjustment disorder, and neurasthenia. Results of two symptom validity tests (Structured Inventory of Malingered Symptomatology, SIMS; Self-Report Symptom Inventory, SRSI) and the Beck Depression Inventory–II (BDI–II) were analyzed.Results: At screening level, 34.5% and 29.8% of the patients were found to presumably overreport symptoms on the SIMS and SRSI, respectively. At the standard cut score of the SRSI (maximum false positive rate: 5%), the proportion of diagnosed overreporting was 18.8%. SIMS and SRSI pseudosymptom endorsement correlated at .73. Highly elevated depressive symptom claims with BDI–II scores above 40, found in 9.3% of the patients, were associated with elevated pseudosymptom endorsement. Moreover, extended times of sick leave and higher expectations of disability pension were associated with elevated pseudosymptom endorsement.Conclusions: The prevalence of symptom overreporting in some clinical patient groups is a serious, yet underinvestigated problem. The current estimates yielded a high prevalence of distorted, noncredible symptom claims in psychosomatic rehabilitation patients. The challenges arising to health professionals working in such settings are immense and need more consideration.

Distress Tolerance and Symptom Severity as Mediators of Symptom Validity Failure in Veterans With PTSD.

Performance validity tests (PVTs) and symptom validity tests (SVTs) are necessary in clinical and research contexts. The extent to which psychiatric distress contributes to failure on these tests is unclear. The authors hypothesized that the relation between posttraumatic stress disorder (PTSD) and validity would be serially mediated by distress tolerance and symptom severity. Participants included 306 veterans, 110 of whom met full criteria for current PTSD. PVTs included the Medical Symptom Validity Test (MSVT) and b Test. The Structured Inventory of Malingered Symptomatology (SIMS) was used to measure symptom validity. MSVT failure was significantly and directly associated with PTSD severity (B=0.05, CI=0.01, 0.08) but not distress tolerance or PTSD diagnosis. b Test performance was not significantly related to any variable. SIMS failure was significantly associated with PTSD diagnosis (B=0.71, CI=0.05, 1.37), distress tolerance (B=-0.04, CI=-0.07, -0.01), and symptom severity (B=0.07, CI=0.04, 0.09). The serial mediation model significantly predicted all SIMS subscales. PTSD severity was associated with failing a memory-based PVT but not an attention-based PVT. Neither PVT was associated with distress tolerance or PTSD diagnosis. SVT failure was associated with PTSD diagnosis, poor distress tolerance, and high symptomatology. For veterans with PTSD, difficulty managing negative emotional states may contribute to symptom overreporting. This may reflect exaggeration or an inability to tolerate stronger negative affect, rather than a "cry for help."

Symptom and performance validation in patients with subjective cognitive decline and mild cognitive impairment

Nonauthentic symptom claims (overreporting) and invalid test results (underperformance) can regularly be expected in a forensic context, but may also occur in clinical referrals. While the applicability of symptom and performance validity tests in samples of dementia patients is well studied, the same is not true for patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). A sample of 54 memory-clinic outpatients with evidence of SCD or MCI was studied. We evaluated the rate of positive results in three validity measures. A total of 7.4% of the patients showed probable negative response bias in the Word Memory Test. The rate of positive results on the Structured Inventory of Malingered Symptomatology was 14.8% while only one participant (1.9%) scored positive on the Self-Report Symptom Inventory using the standard cutoff. The two questionnaires were moderately correlated at .67. In a combined analysis of all results, five of the patients (9.3%) were judged to show evidence of probable negative response bias (or probably feigned neurocognitive impairment). In the current study, a relatively small but nontrivial rate of probable response distortions was found in a memory-clinic sample. However, it remains a methodological challenge for this kind of research to reliably distinguish between false-positive and correct-positive classifications in clinical patient groups.

Reliability, validity, and factorial structure of the Turkish version of the Structured Inventory of Malingered Symptomatology (Turkish SIMS)

Smith and Burger developed the Structured Inventory of Malingered Symptomatology (SIMS) in 1997 as a self-report measure for malingering of psychiatric symptoms. The SIMS consists of 75 dichotomous...

Equivalence of the German and the French Versions of the Self-Report Symptom Inventory

Abstract. Against the background of the growing importance of symptom validity assessment both in forensic and clinical or rehabilitation contexts, a new instrument for identifying overreporting was developed. In order to study the equivalence of the German and the French versions, we divided the item pool of the Self-Report Symptom Inventory (SRSI) into two presumably equivalent half-forms. A sample of 40 adult bilingual Swiss nationals with a mean age of 39.9 years responded honestly to one of the half-forms in German and to the other in French. In a subsequent experimental malingering condition, they were asked to simulate sequelae of a whiplash injury and to respond to the SRSI again. In both conditions, they also filled out the Structured Inventory of Malingered Symptomatology (SIMS). The results showed no differences between the two language versions in both conditions. Classification accuracy was very high (100% specificity, 90% sensitivity for the standard cutoff score). Reliability estimates were 0.93 for endorsement of genuine symptoms and 0.97 for pseudosymptom endorsement. In the malingering condition, the correlation between the number of reported pseudosymptoms and the SIMS scores was 0.69. The current results add to the database available for the SRSI and support the appropriateness of the French version.

Effects of Korsakoff Amnesia on performance and symptom validity testing

Performance validity tests (PVTs) and Symptom validity tests (SVTs) are developed to identify people that present false or exaggerated symptoms. Although a key factor of both types of tests includes relative insensitivity to cognitive disorders, the direct effects of amnesia have been poorly studied. Therefore, a sample of 20 patients diagnosed with Korsakoff Amnesia (KA) through neuropsychological assessment and 20 healthy comparisons (HC) were administered the Test of Memory Malingering (TOMM), the Structured Inventory of Malingered Symptomatology (SIMS), and the newly developed Visual Association Test – Extended (VAT-E). Our results show that KA patients scored systematically lower on the TOMM and VAT-E, while performance on the SIMS was comparable with healthy comparisons. Some KA patients were regarded as underperformers based on the TOMM and VAT-E, suggesting limitations in applying these instruments in severe amnesia. There was a strong interdependence of PVTs in logistic regression. We conclude that the TOMM and VAT-E are not fully robust against severe memory disorders and show a serious risk of false positives. Complete neuropsychological profile analysis is needed, and PVTs should be interpreted with caution in patients with suspected amnesia.

An Inventory of Problems–29 Sensitivity Study Investigating Feigning of Four Different Symptom Presentations Via Malingering Experimental Paradigm

The Inventory of Problems–29 (IOP–29) is a newly developed, self-administered test designed to assist practitioners evaluating the credibility of various symptom presentations. In a recent simulation study comparing real patients against experimental feigners, its classification accuracy compared favorably with that of the Structured Inventory of Malingered Symptomatology and generalized better to different types of symptom reports (i.e., mood- or trauma-related vs. psychosis-related). Extending on these findings, this sensitivity study tested whether the IOP–29 would be similarly accurate in detecting feigning of conditions related to depression, mild traumatic brain injury, posttraumatic stress disorder (PTSD), and schizophrenia. Additionally, it also evaluated the susceptibility of the IOP–29 to uncooperative or random-like responding. Examination of 1,200 IOP–29 records from 400 nonclinical Italian volunteers who took the Italian version of the IOP–29 3 times, in 3 different conditions (i.e., standard instructions, feigned disorder, and random-like responding), confirmed that the IOP–29 might be similarly valid across a wide variety of mental health and cognitive complaints. Indeed, using the standard a priori cutoff of the IOP–29 (i.e., ≥ .50), sensitivity estimates ranged from .86 (for feigned PTSD) to .95 (for feigned depression) and did not significantly differ from one symptom presentation to another. These findings were obtained despite the fact that participants were coached to respond in a believable manner. Interestingly, the random-like responding generated extremely variable IOP–29 scores.

Validity of the Sims scales of neurologic impairment and amnestic disorder

Background: The Structured Inventory of Malingered Symptomatology (SIMS) has never been scientifically validated to demonstrate that it adequately differentiates legitimate patients from malingerers. Method: We evaluated the content validity of the Amnestic Disorder (AM) and Neurologic Impairment (NI) scales of the SIMS via expert ratings by 11 experts (7 psychiatrists, 2 psychologists, and 2 neuroscientists). As the next step, SIMS scores of 23 patients injured in high impact car accidents were selected: seminal research of Bennet Omalu suggests that such collisions would rarely occur without cerebral micro vascular trauma and axonal shearing. Such patients typically suffer from neurological symptoms in the post-concussion whiplash spectrum. Criterion validity of AM and NI scales was assessed by statistical comparisons of AM and NI data of these 23 presumably legitimate patients to published SIMS data on instructed malingerers (30 malingerers of whiplash and 26 malingerers of post-concussive symptoms) and also to published SIMS data on relatively healthy normal controls responding honestly (N=34). Results: The review of item content of the AM and NI scales by the 9 expert clinicians and 2 neuroscientists indicated that all their items represent potentially legitimate medical symptoms: none was being judged as specific to malingering. The SIMS AM and NI scores diagnosed close to 75% of our 23 survivors of high impact motor vehicle accidents (MVAs) as “malingerers:” it is unlikely that there were so many true positives. An ANOVA of NI scores showed that neither malingerers of whiplash nor malingerers of post-concussive symptoms differed significantly from legitimate patients (p>.05) and that normal controls had significantly lower NI scores than both groups of malingerers and also lower scores than the legitimate patients (p<.0001). An ANOVA of AM scores showed that legitimate patients obtained higher AM scores than malingerers of whiplash (p=.0002), but lower scores than malingerers of post-concussive symptoms (p=.0008). In this ANOVA, normal controls had significantly lower AM scores than legitimate patients and also lower scores than malingerers of post-concussive symptoms (p<.001), but did not differ significantly from malingerers of whiplash (p>.05). Conclusions: The SIMS NI and AM scales obviously lack both in content and criterion validity, i.e., the NI and AM scales list legitimate neuropsychological symptoms and cannot adequately differentiate malingerers from legitimate patients.