Symptom Validity Assessment Research Articles

The ecological validity of the IOP-29: A follow-up study using the MMPI-2-RF and the SIMS as criterion variables.

Current guidelines for conducting symptom validity assessments require that professionals administer multiple symptom validity tests (SVTs) and that the SVTs selected for their evaluations provide nonredundant information. However, not many SVTs are currently available, and most of them rely on the same, (in)frequency-based, feigning detection strategy. In this context, the Inventory of Problems (IOP-29) could be a valuable addition to the assessor's toolbox because of its brevity (29 items) and its different approach to assessing the credibility of presented symptoms. As its ecological validity has been poorly investigated, the present study used a criterion groups design to examine the classification accuracy of the IOP-29 in a data set of 174 court-ordered psychological evaluations focused on psychological injury. The validity scales of the Minnesota Multiphasic Personality Inventory-2 Restructured Form and the total score of the Structured Inventory of Malingered Symptoms were used as criterion variables. Overall, the results of this study confirm that the IOP-29 is an effective measure (1.70 ≤ d ≤ 2.67) that provides valuable information when added to the multimethod assessment of symptom validity in civil forensic contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Validity assessment of early retirement claimants: Symptom overreporting on the Beck Depression Inventory – II

Objectives The Beck Depression Inventory-II (BDI-II) is a commonly used clinical measure; however, it contains no method to assess validity of self-report. The primary objective of this research was to examine the possibility of cut scores on the BDI-II indicating possible invalid symptom report in forensic neuropsychological evaluations. Secondary objectives were to explore the utility of education specific cut scores and the effects of the criterion for invalid symptom report. Methods Two hundred and seventeen early retirement claimants (age range 19–64 years) presenting for forensic neuropsychological examination were considered for this study. Invalid symptom report was determined based on two independent self-report symptom validity tests. Further, all individuals completed the BDI-II as part of their routine assessment battery. Results Individuals with invalid symptom report (30.9%) showed significantly higher BDI-II scores compared to individuals passing symptom validity assessment. ROC analysis supports the utility of the BDI-II to differentiate valid from invalid symptom report, AUC = 0.822, SE = 0.032, p < .001, 95%-CI = 0.760–0.884. A BDI-II cut score of 38 points reached a desired level of 0.90 specificity with 0.58 sensitivity. Secondary analysis indicated that the recommended cut score may vary depending on the educational level of the examinee. Further, results seem to be largely robust against the chosen criterion for invalid symptom report. Conclusion The BDI-II appears to be a useful adjunct embedded validity indicator in forensic neuropsychological evaluations.

Performance and symptom validity assessment in attention deficit/hyperactivity disorder: Base rates of invalidity, concordance, and relative impact on cognitive performance

Objective: Differential diagnosis of attention deficit/hyperactivity disorder (ADHD) is one of the most common referral questions for neuropsychological evaluation but is complicated by the presence of external incentives. Validity assessment is therefore critical in such evaluations, employing symptom validity tests (SVTs) and performance validity tests (PVTs) to assess the validity of reported symptoms and cognitive test performance, respectively. This study aimed to establish the base rate of symptom and performance invalidity in adults referred for ADHD, compare concordance between performance and symptom validity, and assess the impact of each type of validity on cognitive test performance. Method: This consecutive case series included data from 392 demographically-diverse adults who underwent outpatient neuropsychological evaluation for ADHD. All patients were administered the Clinical Assessment of Attention Deficit-Adult (CAT-A) and a uniform cognitive test battery, including seven PVTs. Results: Invalid symptom reporting and PVT performance were found in 22% and 16% of the sample, respectively. Sixty-eight percent had concordantly valid SVTs/PVTs and 6% had invalid SVTs/PVTs, whereas the remaining 26% had either invalid SVTs or PVTs (but not both). Invalid PVT performance resulted in a significant decrease across all cognitive test scores, with generally large effects (ηp 2=.01-.18). Invalid symptom reporting had minimal effects on cognitive test performance (ηp 2= ≤.04). Conclusions: PVTs and SVTs are dissociable and therefore should not be used interchangeably in the context of adult ADHD evaluations. Rather, symptom and performance validity should continue to be assessed independently as they provide largely non-redundant information.

On the Use of Eye Movements in Symptom Validity Assessment of Feigned Schizophrenia

Assessing the credibility of reported mental health problems is critical in a variety of assessment situations, particularly in forensic contexts. Previous research has examined how the assessment of performance validity can be improved through the use of bio-behavioral measures (e.g., eye movements). To date, however, there is a paucity of literature on the use of eye tracking technology in assessing the validity of presented symptoms of schizophrenia, a disorder that is known to be associated with oculomotor abnormalities. Thus, we collected eye tracking data from 83 healthy individuals during the completion of the Inventory of Problems – 29 and investigated whether the oculomotor behavior of participants instructed to feign schizophrenia would differ from those of control participants asked to respond honestly. Results showed that feigners had a longer dwell time and a greater number of fixations in the feigning-keyed response options, regardless of whether they eventually endorsed those options (d > 0.80). Implications on how eye tracking technology can deepen comprehension on simulation strategies are discussed, as well as the potential of investigating eye movements to advance the field of symptom validity assessment.

Self-report Measures for Symptom Validity Assessment in Whiplash-associated Disorders

Background/Objective: Whiplash-Associated Disorders (WAD) are one of the most complex conditions to evaluate because several of its symptoms are not observable with current diagnostic methods and cannot be quantified or evaluated correctly. No method is currently available to assess the risk of malingering in the aforementioned condition efficiently. Our aim is to study the capacity of several biopsychosocial psychometric self-report instruments, such as the Brief Pain Inventory (BPI), the Cervical Disability Index (NDI), the SF-36 Health Questionnaire, the Beck Anxiety and Depression Inventories (BDI-II and BAI), or the Brief Illness Perception Questionnaire (BIPQ), to discriminate between patients diagnosed with WAD following a vehicle accident and non-clinical participants with malingering instructions. Method: A simulation design was used with 630 participants: 200 non-clinical controls with honest responding condition, 201 instructed malingerers, and 229 WAD clinical outpatients. Results: Our results showed an AUC range of .60 to .90, with the highest value being that of the BPI (.90), followed by the NDI (.88), and the lowest value that of the BIPQ (.60), followed by the BAI (.71). Conclusions: Overall, the BPI, the NDI, and SF-36 can correctly discriminate between groups with a good specificity (> 90%), while the BAI, BDI, and BIPQ showed a lower capacity, with a high rate of false positives in the case of the BDI and of false negatives in the other two. Practical and research implications are discussed.

Symptom and Performance Validity Assessment: European Trends in Research and Practice

This is a short editorial to the special issue of Psychological Injury and Law. The first of the articles of this issue (Merten et al., Symptom and performance validity assessment in European countries: an update, in this issue) was conceived as the proper introduction. The collection contains eight contributions from authors doing their research in eight different countries (Austria, Belgium, Germany, Great Britain, Italy, the Netherlands, Spain, and Switzerland), using a variety of approaches (review and empirical articles, social security and criminal background, etc.). They describe major research trends and the state-of-the-art of validity assessment across the continent. They also reflect the transition from malingering assessment to validity testing and the extension of this field from forensic applications to clinical and rehabilitation referral contexts.

A Survey of Practices and Beliefs of Italian Psychologists Regarding Malingering and Symptom Validity Assessment

A few years ago, an article describing the current status of Symptom Validity Assessment (SVA) practices and beliefs in European countries reported that there was little research activity in Italy (Merten et al., 2013). The same article also highlighted that Italian practitioners were less inclined to use Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs) in their assessments, compared with their colleagues from other major European countries. Considering that several articles on malingering and SVA have been published by Italian authors in recent years, we concluded that an update of the practices and beliefs of Italian professionals regarding malingering and SVA would be beneficial. Accordingly, from a larger survey that examined general psychological assessment practices and beliefs of Italian professionals, we extracted a subset of items specifically related to malingering and SVA and analyzed the responses of a sample of Italian psychologists who have some experience with malingering-related assessments. Taken together, the results of our analyses indicated that even though our respondents tend to use SVTs and PVTs relatively often in their evaluations, at this time, they likely trust more their own personal observations, impressions, and overall clinical judgment, in their SVA practice. Additionally, our results also indicated that Italian practitioners with some familiarity with malingering-related evaluations consider malingering to occur in about one-third of psychological assessments in which the evaluee might have an interest in overreporting.

Symptom and performance validity in samples of adults at clinical evaluation of ADHD: a replication study using machine learning algorithms

ABSTRACT Introduction Research has shown non-trivial base rates of noncredible symptom report and performance in the clinical evaluation of attention-deficit/hyperactivity disorder (ADHD) in adulthood. The goal of this study is to estimate and replicate base rates of symptom and performance validity test failure in the clinical evaluation of adult ADHD and derive prediction models based on routine clinical measures. Methods This study reuses data of a previous publication of 196 adults seeking ADHD assessment and replicates the findings on an independent sample of 700 adults recruited in the same referral context. Measures of symptom and performance validity (one SVT, two PVTs) were applied to estimate base rates. Prediction models were developed using machine learning. Results Both samples showed substantial rates of noncredible symptom report (one SVT failure: 35.7% – 36.6%), noncredible test performance (one PVT failure: 32.1% – 49.3%; two PVT failures: 18.9% – 27.3%), or both (each one SVT and PVT failure: 13.3% – 22.4%; one SVT and two PVT failures: 9.7% – 13.7%). Machine learning algorithms resulted in generally moderate to weak prediction models, with advantages of the reused sample compared to the independent replication sample. Associations between measures of symptom and performance validity were negligible to small. Conclusions This study highlights the necessity to include measures of symptom and performance validity in the clinical evaluation of adult ADHD. Further, this study demonstrates the difficulty to characterize the group failing symptom or performance validity assessment.

Symptom and Performance Validity Assessment in European Countries: an Update.

In 2013, a special issue of the Spanish journal Clínica y Salud published a review on symptom and performance validity assessment in European countries (Merten et al. in Clínica y Salud, 24(3), 129–138, 2013). At that time, developments were judged to be in their infancy in many countries, with major publication activities stemming from only four countries: Spain, The Netherlands, Great Britain, and Germany. As an introduction to a special issue of Psychological Injury and Law, this is an updated report of developments during the last 10 years. In that period of time, research activities have reached a level where it is difficult to follow all developments; some validity measures were newly developed, others were adapted for European languages, and validity assessment has found a much stronger place in real-world evaluation contexts. Next to an update from the four nations mentioned above, reports are now given from Austria, Italy, and Switzerland, too.

Using the Inventory of Problems-29 (IOP-29) with the Inventory of Problems Memory (IOP-M) in Malingering-Related Assessments: a Study with a Slovenian Sample of Experimental Feigners

A recently published article harshly criticized forensic practitioners operating in Slovenia for not including in their assessments any tests specifically designed to assess negative distortion (Areh, 2020). To promote better forensic assessment practice and stimulate future research on symptom and performance validity assessment in Slovenia, the current study translated the Inventory of Problems-29 (IOP-29; Viglione & Giromini, 2020) and its recently developed memory module (IOP-M; Giromini et al., 2020) into Slovene language and tested their validity and effectiveness by conducting a simulation/analogue study. Among 150 volunteers, 50 completed the IOP-29 and IOP-M under standard instructions; 50 were asked to respond as if they suffered from depression; and 50 were asked to respond pretending to suffer from schizophrenia. Statistical analyses showed that (1) the IOP-29 discriminated well between simulators and honest test-takers (d ≥ 3.56), demonstrating the same effectiveness when inspecting feigned depression (sensitivity = 88%) and feigned schizophrenia (sensitivity = 88%) at an almost perfect specificity (98%); (2) the IOP-M identified 50% of simulators of depression and 80% of simulators of schizophrenia at perfect specificity (100%); and (3) combining the results of the IOP-29 with those of the IOP-M notably improved classification accuracy so as to demonstrate incremental validity. Taken together, these findings provide initial support for using the IOP-29 and IOP-M in applied settings in Slovenia. Limitations related to the design of the study and recommendations for further research are provided.

American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: Update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term ‘malingering.’ Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures.

Comparison of Clinical Psychologist and Physician Beliefs and Practices Concerning Malingering: Results from a Mixed Methods Study

Malingering, or intentional feigning of impairment for an external incentive, has been the topic of extensive psychological research in recent decades. The emphasis on symptom validity assessment in training, practice, and research in clinical psychology is not echoed across other health professions. While past surveys of clinical psychologists revealed positive beliefs and attitudes toward validity assessment, much less is known about physicians in this area, particularly in regard to how they identify suspected malingering. To address this gap, we surveyed a sample of demographically similar clinical psychologists (n = 57) and physicians (n = 54) regarding their beliefs and practices about malingering. Unique to this study was the use of a mixed survey and mixed methods approach to analyzing quantitative and qualitative data. Broadly, survey findings indicated that more clinical psychologists reported documenting malingering in their careers compared with physicians (65.0% vs. 33.0%). Consistently, more clinical psychologists endorsed “always” or “often” being able to recognize malingering compared with physicians (73.7% vs. 22.2%). Clinical psychologists indicated that they ask patients or evaluees about potential external incentives (e.g., current involvement in litigation) much more often than physicians (70.0% vs. 16.0%). On average, clinical psychologists estimated higher base rates of malingering in six high-risk malingering diagnostic categories compared with physicians, with greatest estimation difference noted for mild traumatic brain injury (19.9% vs. 5.9%). Qualitative examination of respondent data generally converged with quantitative findings and provided additional insights to how conceptualizations of malingering differ across healthcare disciplines. Implications for practice and study limitations are discussed.

Comparison of the Word Memory Test and the Test of Memory Malingering in detecting invalid performance in neuropsychological testing

Given the prevalence of compensation seeking patients who exaggerate or fabricate their symptoms, the assessment of performance and symptom validity throughout testing is vital in neuropsychological evaluations. Two of the most commonly utilized performance validity tests (PVTs) are the Word Memory Test (WMT) and the Test of Memory Malingering (TOMM). While both have proven successful in detecting invalid performance, some studies suggest greater sensitivity in the WMT relative to the TOMM. To improve upon previous research, this study compared performance in individuals who completed both the WMT and TOMM during a neuropsychological evaluation. Participants included 268 cases from a clinical private practice consisting of primarily disability claimants. One-way multivariate analysis of variance (MANOVA) compared neuropsychological performance of participants who passed both PVTs (n = 198) versus those who failed the WMT but passed the TOMM (n = 70). Global suppression of neuropsychological scores was found for participants who failed the WMT but passed the TOMM, as well as more psychiatric symptoms reported on questionnaires, relative to those who passed both PVTs. These findings suggest that those passing the TOMM but failing the WMT demonstrated performance invalidity, which illustrates the WMT’s enhanced sensitivity.

Beyond Rare-Symptoms Endorsement: a Clinical Comparison Simulation Study Using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) with the Inventory of Problems-29 (IOP-29)

To date, the MMPI-based, rare-symptom detection strategy is considered one of the most effective ones in symptom validity assessment. Because many of the items of the Inventory of Problems-29 (IOP-29) were designed specifically to provide incremental validity over the MMPI F scales, this study tested whether using the IOP-29 in combination with the MMPI-2 would provide higher classification accuracy compared to using either instrument alone. A total of 155 Italian adult individuals contributed to this study. About half (n = 93) were experimental malingerers (expMAL) instructed to simulate depression without being detected as feigners. The others were either (a) depressed patients in treatment (n = 36) or (b) individuals evaluated for possible malingering associated with work-related stress and considered to be genuinely affected by depression (n = 26). All were administered the Italian versions of both the MMPI-2 and the IOP-29. As expected, both instruments were highly effective in discriminating feigned from bona fide depression, with AUC values ranging from .77 to .90. More importantly, when entering the IOP-29 after each of the MMPI-2 scales under consideration (i.e., F, Fb, and Fp), the logistic regression models predicting group membership (0 = patient; 1 = expMAL) improved significantly. Likewise, each of the three MMPI-2 scales under consideration also significantly improved the prediction of group membership, when entered after the IOP-29. These findings thus indicate that using the MMPI-2 together with the IOP-29 could provide incremental validity over using either instrument alone, when testing depression-related complaints.

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.

Montreal Cognitive Assessment as a screening tool: Influence of performance and symptom validity.

We evaluated Montreal Cognitive Assessment (MoCA) performance in a veteran traumatic brain injury (TBI) population, considering performance validity test (PVT) and symptom validity test (SVT) data, and explored associations of MoCA performance with neuropsychological test performance and self-reported distress. Of 198 consecutively referred veterans to a Veterans Administration TBI/Polytrauma Clinic, 117 were included in the final sample. The MoCA was administered as part of the evaluation. Commonly used measures of neuropsychological functioning and performance and symptom validity were also administered to aid in diagnosis. Successively worse MoCA performances were associated with a greater number of PVT failures (ps < 0.05). Failure of both the SVT and at least 1 PVT yielded the lowest MoCA scores. Self-reported distress (both posttraumatic stress disorder symptoms and neurobehavioral cognitive symptoms) was also related to MoCA performance. Performance on the MoCA is influenced by task engagement and symptom validity. Causal inferences about neurologic and neurocognitive impairment, particularly in the context of mild TBI, wherein the natural course of recovery is well known, should therefore be made cautiously when such inferences are based heavily on MoCA scores. Neuropsychologists are well versed in the assessment of performance and symptom validity and thus may be well suited to explore the influences of abnormal performances on cognitive screening.

Using the inventory of problems – 29 (IOP-29) with the Test of Memory Malingering (TOMM) in symptom validity assessment: A study with a Portuguese sample of experimental feigners

This study tested whether combining the Inventory of Problems – 29 (IOP-29) with the Test of Memory Malingering (TOMM) would increase sensitivity in the detection of experimentally feigned mental health problems, compared to using either test alone. Additionally, it also evaluated (a) the effects of administration order of these two tests and (b) the cultural and linguistic applicability of these tests to a European Portuguese population. The IOP-29 and TOMM were administered to a community sample of 100 nonclinical, adult volunteers from Portugal, with the instruction to feign mental health problems. Half were instructed to feign mild traumatic brain injury (mTBI) symptoms, half were instructed to feign major depression. Administration order had no effects on the tests’ scores, and both measures produced excellent sensitivity values, ranging from .82 to .98 for the TOMM, and from .88 to 1.00 for the IOP-29, when using standard a priori cutoff scores. More importantly, combining the results of TOMM with those of IOP-29 notably increased sensitivity compared to using either test alone. This study thus supports the use of the IOP-29 together with the TOMM in multimethod symptom validity assessments and provides initial evidence that both tests can be used also in Portugal.

Antisocial features are not predictive of symptom exaggeration in forensic patients

PurposeTo investigate the predictive value of antisocial personality disorder (ASPD) and features of ASPD (i.e., lack of remorse, blame externalization, and deceitfulness) for symptom exaggeration.MethodsA sample of forensic psychiatric patients (N = 57) was asked to complete several self‐report instruments (measuring symptom exaggeration, lack of remorse, blame externalization, and offense minimization) and a semi‐structured interview about their most recent offense. To quantify patients’ deceitfulness, the information collected via the semi‐structured interview was checked against the official records of patient's offenses. Additionally, patient's mental disorders and the extent to which patients denied their delinquency were determined by gathering clinician's judgement on this matter from patient records. The relation between symptom exaggeration and the potential predictors of symptom exaggeration was examined through correlational analyses and cross‐tabulation of prevalence rates of symptom exaggeration with prevalence rates of the potential predictors.ResultsAntisocial personality disorder was not a useful predicator of symptom exaggeration. Also, patients who showed little regret for their offenses, or tended to blame their offenses on external factors, or minimized their delinquency, or were inaccurate when reporting their delinquency, had similar levels of symptom exaggeration as those without these tendencies.ConclusionsNeither ASPD nor antisocial traits, including lack of remorse, blame externalization, and deceitfulness, were meaningfully related to symptom exaggeration and therefore should have no place in the assessment of symptom validity or the detection of malingering. On the contrary; focusing on antisocial traits as indicators of symptom exaggeration is likely to result in large portions of misclassifications.

Differentiating Factitious from Malingered Symptomatology: the Development of a Psychometric Approach

Psychometric symptom validity assessment is becoming increasingly part and parcel of psychological and neuropsychological assessments. An unresolved and rarely addressed issue concerns the differentiation between factitious and malingered symptom presentations: present-day symptom validity tests can assess whether an examinee presents with noncredible symptomatology, but not why an examinee does so. We explored this issue by developing the Symptom and Disposition Interview (SDI); a symptom validity test that incorporates strategies intended to gauge internal incentives associated with factitious disorder. The merits of the SDI were explored and compared to a traditional symptom validity test (the Structured Inventory of Malingered Symptomatology) in two analogue studies, each with factitious and malingering conditions (n = 24–30 per condition) and a clinical control group (n = 34, n = 40). Overall, the results were positive: The SDI was as effective in detecting feigned symptom presentations as a traditional symptom validity test and superior in differentiating factitious from malingered symptom presentations. We conclude that the SDI is not ready for clinical use, but that psychometric approaches to the assessment of factitious symptomatology, such as the SDI, appear sufficiently promising to warrant future research.

Clinical tests for symptom validity assessment

Assessing symptom validity is essential both in the clinical and medicolegal contexts. If neurological symptoms are demonstrated and/or a patient complains of pain that is not or cannot be fully explained by an underlying disease, it is necessary to recognize reliably a possible psychological cause in order to avoid further unnecessary examinations. In the medicolegal context, malingering or exaggeration of complaints for obtaining financial benefit is to be differentiated in a further step. The present overview contains a summary of clinical observations and tests for neurologists and psychiatrists used for symptom validity assessment of sensorimotor symptoms, tremor, gait, equilibrium and visual disturbances as well as pain.