Test Of Memory Malingering Scores Research Articles

82 Single Errors on Trial 1 of the Test of Memory Malingering may be Indicative of Invalid Performance on Neuropsychological Measures in a Sample of Youth Athletes

Objective:The Test of Memory Malingering (TOMM) is a performance validity test (PVT) that aims to assess whether participants are giving adequate effort to perform well on tasks of memory performance (Tombaugh, 1996). Other PVTs, specifically the Forced Choice Recognition Trial in the California Verbal Learning Test, have shown that even single errors may indicate invalid performance (Erdodi et al., 2018). Finally, youth are often understudied in the PVT literature, and athletes are at increased risk of invalid performance on baseline testing due to many wanting to return to play following concussion (Erdal, 2012). Therefore, the objective of the current study is to examine whether single errors on TOMM Trial 1 are indicative of lower, and possibly invalid, cognitive performance in a youth sample, given that cognitive performance declines with even small decreases in effort (Green, 2007).Participants and Methods:Healthy youth athletes (n=174) aged 8-16 years (M=12.07) completed the TOMM as well as other neuropsychological measures during baseline neuropsychological evaluation in a clinical research program for sports concussion. Independent samples t-tests compared youth athletes who scored 49 points on the TOMM (n=28) to youth athletes who scored a perfect 50 (n=50) across several groupings of neuropsychological measures. Participants who scored less than 49 or who didn’t complete the TOMM were excluded from the analyses.Results:Participants scoring 50/50 on TOMM Trial 1 scored significantly higher on Stroop Color Naming task (p=0.036), Verbal Learning Delayed task from the second edition of the Wide Range Assessment of Learning and Memory (WRAML-2, p=0.018), and Letter Number Sequencing task from the Weschler Intelligence Scale for Children (WISC-IV, p=0.025), relative to participants scoring 49/50. Though not statistically significant, results also showed a trend toward participants scoring 50/50 scoring higher on nearly every test in the battery.Conclusions:Participants with a single error on TOMM Trial 1, as compared to participants with a perfect score, performed significantly worse on a processing speed task, a verbal learning task, and a working memory task as part of a comprehensive neuropsychological battery. The single-error group also trended toward scoring lower on nearly all of the remaining attention, processing speed, perceptual ability, memory, and executive functioning tasks in the battery. The results could lead to a more liberal interpretation of TOMM scores, given that the trend towards lower performance may be due to putting forth significantly less effort. These results point to the need for a similar comparison of the TOMM in a larger sample size, as greater power may reveal even more significant differences in performance. Findings also emphasize the importance of viewing performance validity on a continuum rather than as a dichotomous pass/fail. Understanding the TOMM and how single errors may be indicative of poorer performance in a youth sample could help to reframe the way PVT results are interpreted in clinical and forensic settings.

B - 107 Exploratory Analysis of the Relationship between Health Anxiety (HA) and Neuropsychological Performance in a Validity Controlled Sample of Patients with Post-Acute Sequelae of COVID-19 (PASC).

Since the emergence of COVID-19, research has consistently indicated cognitive difficulties as a primary complaint after infection (Altuna et al., 2021). It is unclear to what extent these cognitive deficits may be attributable to, or exacerbated by, health anxiety (HA) (Venkataramani et al., 2022). This study explored the relationship between HA and cognition in a performance validity controlled sample of patients with PASC complaints. Participants included patients referred for a focused neuropsychological evaluation for persistent cognitive complaints after COVID infection (N = 19). Participants were excluded for Test of Memory Malingering scores below standard cutoff. The sample mean age was 43years (SD = 12.9), 57.9% were female, and 47.4% were from minority racial/ethnic groups. HA was assessed using the Short Health Anxiety Inventory (SHAI). Cognitive abilities were measured using the Wechsler Adult Intelligence Scale-IV (WAIS-IV: Processing Speed Index [PSI]; Letter-Number Sequencing [LNS]) and Trail Making Test Part-A (TMT-A). Regression analyses were conducted to assess the extent to which HA predicts cognitive performance. The SHAI main subscale significantly predicted TMT-A [β= -3.93, p < 0.01] and WAIS-IV PSI [β= -4.60, p = 0.04]. The SHAI negative consequences subscale significantly predicted TMT-A [β= -4.64, p = 0.04] and WAIS-IV LNS [β= 0.49, p = 0.048]. Findings suggest that general HA predicted PSI, while fear of negative health outcomes predicted LNS. Basic attention abilities were predicted by global HA. Future studies will benefit from evaluating the moderating effect of HA on the relationship between subjective symptom severity and cognition.

A - 125 Posttraumatic Stress Disorder Symptom Severity and its Relationship to Performance on the Test of Memory Malingering in a Veteran Sample.

To examine relationships between Posttraumatic Stress Disorder (PTSD) symptom severity and performance on the Test of Memory Malingering (TOMM) trials in veterans without a diagnosis of neurocognitive disorder. A sample of 47 clinically-referred veterans (80.9% male; Mage = 57.47, SD = 14.83; Medu = 13.91, SD = 2.5) who did not meet criteria for a neurocognitive disorder completed the PTSD Checklist for DSM-5 (PCL-5) and the TOMM. Primary diagnoses included PTSD (48.9%), no diagnosis (23.4%), and depression (19.1%). A cutoff of 45 was used for each trial; 47 completed Trial 1 (TOMM-T1), 17 completed Trial 2 (TOMM-T2), and 10 completed Retention Trial (TOMM-Ret). Nine participants (19.1%) failed the TOMM. Analyses included Pearson correlation, Spearman correlation, and independent-samples t-tests. Age was negatively correlated with PCL-5 and positively correlated with TOMM-T1; therefore, relevant partial correlations were conducted. TOMM-T1 demonstrated a moderate, negative correlation with PCL-5, rs(45) = -0.469, p < 0.001, 95%CI(-0.688,-0.248). A moderate non-significant correlation was found between TOMM-T2 and PCL-5, rs(15) = -0.405, p = 0.053, 95%CI(-0.775,0.014). PCL-5 and TOMM-Ret were not correlated. Controlling for age, the correlation between PCL-5 and TOMM-T1 remained significant (rs[44] = -0.426, p = 0.002). Those who passed TOMM (M = 38.45, SD = 16.48) had significantly lower PCL-5 scores compared to those who failed (M = 57.67, SD = 13.83), t(45) = -3.231, p = 0.001, Cohen's D = 16.04. Among veterans, PTSD symptom severity was related to TOMM scores and/or failure. Findings highlight a need to consider the role PTSD symptoms may play in neuropsychological assessment. Findings further support recommendations for trauma-focused treatment before formal neuropsychological testing, as psychiatric symptoms may interfere with obtaining a valid assessment of cognition.

An alternative approach to TOMM cutoff scores using a large sample of military personnel

The accuracy of neuropsychological assessments relies on participants exhibiting their true abilities during administration. The Test of Memory Malingering (TOMM) is a popular performance validity test used to determine whether an individual is providing honest answers. While the TOMM has proven to be highly sensitive to those who are deliberately exaggerating their symptoms, there is a limited explanation regarding the significance of using 45 as a cutoff score. The present study aims to further investigate this question by examining TOMM scores obtained in a large sample of active-duty military personnel (N = 859, M = 26 years, SD = 6.14, 97.31% males, 72.44% white). Results indicated that no notable discrepancies existed between the frequency of participants who scored a 45 and those who scored slightly below a 45 on the TOMM. The sensitivity and specificity of the TOMM were derived using the forced-choice recognition (FCR) scores obtained by participants on the California Verbal Learning Test, Second Edition (CVLT-II). The sensitivity for each trial of the TOMM was 0.84, 0.55, and 0.63, respectively; the specificity for each trial of the TOMM was 0.69, 0.93, and 0.92, respectively. Because sensitivity and specificity rates are both of importance in this study, balanced accuracy scores were also reported. Results suggested that various alternative cutoff scores produced a more accurate classification compared to the traditional cutoff of 45. Further analyses using Fisher’s exact test also indicated that there were no significant performance differences on the FCR of the CVLT-II between individuals who received a 44 and individuals who received a 45 on the TOMM. The current study provides evidence on why the traditional cutoff may not be the most effective score. Future research should consider employing alternative methods which do not rely on a single score.

Low rate of performance validity failures among individuals with bipolar disorder.

Assessing performance validity is imperative in both clinical and research contexts as data interpretation presupposes adequate participation from examinees. Performance validity tests (PVTs) are utilized to identify instances in which results cannot be interpreted at face value. This study explored the hit rates for two frequently used PVTs in a research sample of individuals with and without histories of bipolar disorder (BD). As part of an ongoing longitudinal study of individuals with BD, we examined the performance of 736 individuals with BD and 255 individuals with no history of mental health disorder on the Test of Memory Malingering (TOMM) and the California Verbal Learning Test forced choice trial (CVLT-FC) at three time points. Undiagnosed individuals demonstrated 100% pass rate on PVTs and individuals with BD passed over 98% of the time. A mixed effects model adjusting for relevant demographic variables revealed no significant difference in TOMM scores between the groups, a = .07, SE = .07, p = .31. On the CVLT-FC, no clinically significant differences were observed (ps < .001). Perfect PVT scores were obtained by the majority of individuals, with no differences in failure rates between groups. The tests have approximately >98% specificity in BD and 100% specificity among non-diagnosed individuals. Further, nearly 90% of individuals with BD obtained perfect scores on both measures, a trend observed at each time point.

Cross-validation of the Utility of Test of Memory Malingering (TOMM) Cut-offs in a Large Colombian Sample

This study sought to cross-validate the utility of Test of Memory Malingering (TOMM) cut-offs derived in a large Colombian sample with further exploration of the impact of age, education, and Mini-Mental Status Examination (MMSE) scores on TOMM trials. To address these aims, the study examines concordance rates of the TOMM scores by demographics and Hopkins Verbal Learning Test-Revised (HVLT-R) test performance. Additionally, item response theory analysis (IRT) focused on the interaction between demographic variables and the psychometric properties of the TOMM items. Data were collected from 1416 healthy controls (58.6% female; M age = 58.19; M education = 9 years) who completed the TOMM, MMSE, and HVLT-R as part of a comprehensive battery conducted in Spanish. Frequency analysis was used to assess for concordance rates of passing TOMMe10, Trial 1, and Trial 2 scores, further broken down by median split for MMSE, education, and age. Additionally, IRT is used to examine, in detail, the psychometric properties of the TOMM items and relationships to demographic variables. Validity classification differed across the TOMM trials, with 82.8% passing e10, 88.6% Trial 1, and 92.5% Trial 2. When dichotomized by a median split, passing rates across all TOMM trials were significantly different (p ≤ .001) for MMSE scores, education, and age with the largest discrepancy (~ 21%) observed on TOMMe10. IRT confirmed that all TOMM items are easy to answer correctly with Trial 2 items being appreciably easier (difficulty range = − 4.90 to − 1.52) than Trial 1 items (difficulty range = − 6.22 to − 3.50). Age, education, MMSE, and HVLT-R scores all were significantly related to latent trait scores on the TOMM (p < .001). Utilization of the TOMM in Spanish-speaking individuals is warranted, but with caution. The TOMMe10 yielded higher rates of invalid classification when compared to Trial 1 or Trial 2. IRT methods allow examination of whether traditional TOMM trial cut-offs may be appropriate when individuals present with advanced age or low educational attainment.

Rey 15 item test plus recognition trial and TOMM in a community pediatric sample

In pediatric evaluations, performance validity test (PVT) selection is often constrained by reading level, developmental appropriateness of stimuli, and administration time. The Rey 15 Item Test (FIT) addresses these constraints, and ranks among the most frequently used PVTs. Unfortunately, research indicates poor sensitivity of the FIT recall trial. Boone et al. developed a FIT recognition trial and demonstrated in an adult sample that its use increased sensitivity while maintaining high specificity. These results are promising, but, to the authors’ knowledge, have only been replicated once in a pediatric sample. The present study examined the FIT plus recognition trial in a sample of 72 young athletes ages 8–16 years. All data for the present study were collected during baseline cognitive evaluations. The Test of Memory Malingering (TOMM) was used as the comparison criterion. Receiver operating characteristic curve analyses showed the addition of the recognition trial did not substantially improve sensitivity of the FIT. There was a surprising lack of concordance between TOMM and FIT scores, and, whereas the FIT correlated with multiple cognitive measures, the TOMM did not correlate with any other measures. Results suggest the FIT is not appropriate for pediatric clinical care, even with the additional recognition trial.

Early Cutoff Criteria for Strong Performance on the Test of Memory Malingering.

The Test of Memory Malingering (TOMM) is widely used to assess performance validity. To improve efficiency, we investigated whether abbreviated administration (i.e., only the first 25 items of Trial 1 [T1]) is possible when effort is very strong (≥49/50 on T1 or T2). We collected TOMM scores of 501 consecutive adult patients ranging in cognitive status who underwent standard neuropsychological evaluation at Mayo Clinic, Rochester, MN. Receiver Operating Characteristic (ROC) analysis showed excellent area under the curve (AUC) (0.94; CI95% [0.92, 0.97]) and a cutoff of 25/25 had 100% specificity for identifying strong performance. Of the 224 patients who obtained a perfect score on the first 25 items, 197 (88%) obtained ≥49 on T1 and the remaining patients (n=27) obtained ≥49 on T2. A perfect score on the first 25 items of the TOMM predicted overall strong performance 100% of the time, supporting abbreviated administration in select cases in a general outpatient clinical setting.

A-70 Beyond Validity: The Utility of the Test of Memory Malingering in Assessing Cognitive Functioning in Veterans

Abstract Objective The objective of the present analyses was to replicate analyses from an interim sample which found that scores on the Test of Memory Malingering (TOMM) predicted objective cognitive outcomes in the domains of attention and verbal learning even when invalid TOMM scores were excluded. Methods Participants consisted of 92 United States Veterans from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) enrolled at the VA Portland Health Care System and recruited for a larger study on the role of blast exposure. Veterans were included if they had a valid performance on the TOMM (Trial 2 score &gt; 47) were not currently substance dependent. Data was analyzed through linear regressions examining raw TOMM Trial 1 scores to predict objective cognitive performance on measures of memory and attention from the Neuropsychological Assessment Battery (NAB). Results In performance on the tasks of Driving Scenes (Beta = .328, p &lt; .01), Initial Story Learning (Beta = .209, p &lt; .05), and Attention Index Percentile (Beta = .208, p &lt; .05) of the NAB, TOMM Trial 1 was a significant predictor. TOMM scores were also predictive of years of education (Beta = .303, p &lt; .01). Conclusion These findings replicate results derived from interim data. TOMM Trial 1 significantly predicted objective cognitive performance in OEF/OIF Veterans even when invalid performance was excluded. This suggests that TOMM has a utility in assessing cognitive functioning and not just valid performance. Similarly, results also suggest that the TOMM may be sensitive to education as well.

Detecting clinical and simulated dissociative identity disorder with the Test of Memory Malingering.

Few studies have assessed malingering in individuals with complex trauma and dissociation. This is concerning because these individuals' severe and ranging symptoms are associated with elevations on some, but not all, validity scales that detect symptom exaggeration. Dissociative individuals may experience dissociative amnesia, yet no study to date has examined how to distinguish clinical from malingered amnesia with dissociative samples. The current study examined whether the Test of Memory Malingering (TOMM) can accurately distinguish patients with clinically diagnosed dissociative identity disorder (DID) and simulators coached to imitate DID. Utility statistics classify individuals' TOMM scores as suggestive of clinical or simulated DID. TOMM scores from 31 patients diagnosed with DID via structured interviews were compared to those of 74 coached DID simulators. Discriminant analyses found scores from TOMM Trials 1 and 2 and total TOMM scores accurately classified clinical or simulated DID group status. In addition, TOMM Trial 1 demonstrated high specificity (87%) and positive predictive power (94%), as well as moderate sensitivity (78%), negative predictive power (63%), and overall diagnostic power (81%). Despite exposure to DID-specific information, simulators were not able to accurately feign the DID group's TOMM scores, which is inconsistent with the iatrogenic/sociocultural model of DID. The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Cognitive functioning in fibromyalgia: The central role of effort

ObjectiveFibromyalgia syndrome (FM) patients demonstrate deficits in tests of attention, executive functioning and verbal memory. We assessed the role of effort in the cognitive impairment in FM patients, alongside common symptoms of pain, fatigue and depression. Method50 FM patients underwent a computerized cognitive assessment battery including memory, executive function, attention and information processing speed (NeuroTrax Corp.). Age and education standardized scores were computed. Effort was assessed by the Test of Memory Malingering (TOMM). FM symptoms were assessed by the Fibromyalgia Impact Questionnaire (FIQ), Widespread Pain Index (WPI) and Symptom Severity Scale (SSS), a Visual Analog Scale (VAS) of clinical pain and the Beck Depression Inventory (BDI-2). ResultsFM patients showed impaired performance on the memory, attention and information processing speed domains. According to the TOMM, sub-optimal effort was shown by 16% of patients. TOMM scores were not associated with pain, fatigue or depression. After controlling for effort, no significant impairment was found in memory scores; however attention and information processing speed scores remained significantly low. Multiple regressions analysis, performed in order to evaluate the contribution of effort, pain, fatigue and depression, found effort to be the only significant variable accounting for variance of cognitive scores on all domains. ConclusionThe findings confirm impaired attention and processing speed in FM patients, independent of effort level. Nonetheless, the findings point to a general and strong effect of effort on neuropsychological performance in FM patients, especially in the domain of memory, emphasizes the importance of effort testing in this population.

Predicting Test of Memory Malingering and Medical Symptom Validity Test Failure within a Veterans Affairs Medical Center: Use of the Response Bias Scale and the Henry-Heilbronner Index

The ability of the Response Bias Scale (RBS) and the Henry-Heilbronner Index (HHI), along with several other MMPI-2 validity scales, to predict performance on two separate stand-alone symptom validity tests, the Test of Memory Malingering (TOMM) and the Medical Symptom Validity Test (MSVT), was examined. Findings from this retrospective data analysis of outpatients seen within a Veterans Affairs medical center (N = 194) showed that group differences between those passing and failing the TOMM were largest for the RBS (d = 0.79), HHI (d = 0.75), and Infrequency (F; d = 0.72). The largest group differences for those passing versus failing the MSVT were greatest on the HHI (d = 0.83), RBS (d = 0.80), and F (d = 0.78). Regression analyses showed that the RBS accounted for the most variance in TOMM scores (20%), whereas the HHI accounted for the most variance in MSVT scores (26%). Nonetheless, due to unacceptably low positive and negative predictive values, caution is warranted in using either one of these indices in isolation to predict performance invalidity.

Derivation and Clinical Validation of Consistency Indices on the Test of Memory Malingering

Response consistency (CNS) is considered in free-standing performance validity measures like the Medical Symptom Validity Test (MSVT). This study examined the utility of CNS scores on the Test of Memory Malingering (TOMM). CNS indices were derived in a non-clinical undergraduate sample randomized to control (n = 73), naïve simulator (n = 73), and coached simulator (n = 73) groups. Two of the three TOMM CNS measures showed higher classification rates identifying naïve simulators than the standard TOMM criteria; CNS measures classified coached simulators better than the standard TOMM criteria. Coached simulators outperformed naïve simulators on the standard TOMM scores, but not on CNS measures, suggesting their resilience to coaching. In a separate clinical sample of veterans (N = 92), TOMM CNS scores exhibited comparable classification rates with the standard TOMM scoring using the MSVT as the performance validity criterion. Overall, findings support TOMM CNS scores, especially in settings in which examinee coaching is likely.

The Influence of Effort on Neuropsychological Performance in Children: Is Performance on the TOMM Indicative of Neuropsychological Ability?

The Test of Memory Malingering (TOMM) is a measure of effort that has traditionally been utilized with adults but is being increasingly used with children, though it is not yet entirely clear what suboptimal TOMM performance means in terms of neuropsychological test scores. The purpose of this study was to investigate whether performance on the TOMM can be used as a predictive marker for neuropsychological performance in children. Participants (N = 75) completed the TOMM, Wechsler Intelligence Scale for Children-Fourth Edition, Wisconsin Card-Sorting Test (WCST), Children's Memory Test, and Delis-Kaplan Executive Function System Trails. Results revealed significant correlations between age, education level, IQ, and many of the neuropsychological measures administered, indicating that as children's TOMM scores increase, so do their cognitive performances. Children were subsequently divided into two groups: optimal effort and suboptimal effort, based on their TOMM Trial 2 scores. Results suggest significant differences in IQ performance and WCST Failure to Maintain Set; however, there were no differences in regard to any other neuropsychological measures administered. It was also found that a larger proportion of the younger children (aged 6 to 10 years old) scored below the TOMM cutoff compared with older children. This study illustrates that although correlations exist, suboptimal effort on the TOMM may not predict poorer performance on a neuropsychological evaluation in children as has been reported in other studies.

Performance and Specificity Rates in the Test of Memory Malingering: An Investigation Into Pediatric Clinical Populations

Symptom validity tests are becoming standard as an effort measure during pediatric neuropsychological assessment. An important component of symptom validity test use is understanding limitations of these measures and how select clinical groups may have difficulty with them. Research has begun to clarify the limits of the Test of Memory Malingering (TOMM) with diverse childhood diagnoses. This study compared TOMM scores of children (N = 86) classified with common childhood disorders. Findings suggest that a substantial proportion of children performed below the recommended cutoff score of 45 on Trial 2 and attained varied specificity rates. This included children with conduct disorders (85%), affective disorders (92%), traumatic brain injury (83%), attention-deficit hyperactivity disorder (93%), learning disabilities (100%), and pervasive developmental disorder (88%). The group with the most children scoring below the cutoff was children with intellectual disabilities (76%). This finding is consistent with some of the adult research suggesting that very limited cognitive ability may compromise TOMM performance. Caution may be necessary when drawing conclusions about test-taking effort based on the recommended TOMM cutoff scores when evaluating children with disabilities.

Administration Order Effects on the Test of Memory Malingering

Using a sample of 72 university students, we determined whether administering the Boston Naming Test (BNT) before the Test of Memory Malingering (TOMM) affects scores on the latter test and whether administration of a visual test during the interval between TOMM Trial 2 and the TOMM Retention Trial (TOMM-R) influences results on TOMM-R. Four orders of administration were used. A series of nonparametric tests indicated that when the BNT was given before the TOMM, a lower median TOMM Trial 1 (TOMM-1) score emerged. However, of the 36 participants who completed the BNT prior to administration of the TOMM, only one achieved a score < 45 on TOMM-1. There were no other significant findings. Overall, the results suggest that order of test administration is probably not a determinant of TOMM scores.

Relationship between suboptimal cognitive effort and the clinical scales of the Personality Assessment Inventory

Little research has examined the relationship between the Personality Assessment Inventory (PAI) and cognitive effort. The current study extends the research on personality assessment and suboptimal cognitive effort by evaluating the relationship between the PAI clinical scales and the Test of Memory Malingering (TOMM) in a neuropsychological population. Utilizing corrections for multiple comparisons, rank-order correlations with the TOMM Trial 2 (T2) and the PAI clinical scales indicated a significant relationship with the SOM (rho = −.26, p <.001), with additional scales (SCZ, ANX, and DEP) trending toward significance. Analysis of SOM subscales indicated a significant relationship between SOM-C and T2 as well. To further explore the relationship between SOM and the TOMM, ANOVA results indicated that individuals scoring within normal limits on the SOM had higher mean TOMM scores than those with extremely elevated SOM. Additional analyses indicated that utilizing the cut-off for extreme responding on the SOM scale (T > 87) had adequate sensitivity (93%) and specificity (76%) in predicting TOMM performance, with a positive predictive power of 54% and a negative predictive power of 97%, resulting in a 91% correct classification rate. Thus, the evidence suggests that extreme scores on SOM should prompt careful evaluation for suboptimal cognitive effort.

Assessing Effort During Neuropsychological Evaluation with the TOMM in Children and Adolescents with Epilepsy

Effort assessment is of particular importance in pediatric epilepsy where neuropsychological findings may influence treatment decisions, especially if surgical interventions are being considered. The present investigation examines the Test of Memory Malingering (TOMM) in 60 children and adolescents with epilepsy. The overall pass rate for the sample was 90%. TOMM scores were unrelated to age, though there was a significant correlation between TOMM Trial 2 scores and intelligence estimates. Overall, the TOMM appears to be a valid measure of effort in young epilepsy patients, though caution should be used when interpreting scores for those with very low IQ, especially if behavioral problems are also evident. Caution should also be exercised in interpreting scores in children with ongoing interictal epileptiform activity that may disrupt attention.

Detecting Malingered Pain-Related Disability: Classification Accuracy of the Test of Memory Malingering

This study used criterion groups validation to determine the accuracy of the Test of Memory Malingering (TOMM) in detecting malingered pain-related disability (MPRD) across a range of cutoffs in chronic pain patients undergoing psychological evaluation (n = 604). Data from patients with traumatic brain injury (n = 45) and dementia (n = 59) are presented for comparison. TOMM scores decreased and failure rates increased as a function of greater external evidence of intentional under-performance. The TOMM detected from 37.5% to 60.2% of MPRD patients, depending on the cutoff. False positive (FP) error rates ranged from 0% to 5.1%. Accuracy data for Trial 1 are also reported. In chronic pain the original cutoffs produced no FP errors but were associated with high false negative error rates. Higher cutoffs increased sensitivity without adversely affecting specificity. The relevance of these findings to research and clinical practice is discussed.

Distinguishing between Neuropsychological Malingering and Exaggerated Psychiatric Symptoms in a Neuropsychological Setting

It is unclear whether symptom validity test (SVT) failure in neuropsychological and psychiatric domains overlaps. Records of 105 patients referred for neuropsychological evaluation, who completed the Test of Memory Malingering (TOMM), Reliable Digit Span (RDS), and Millon Clinical Multiaxial Inventory–III (MCMI–III), were examined. TOMM and RDS scores were uncorrelated with MCMI–III symptom validity indices and factor analysis revealed two distinct factors for neuropsychological and psychiatric SVTs. Only 3.5% of the sample failed SVTs in both domains, 22.6% solely failed the neuropsychological SVT, and 6.1% solely failed the psychiatric SVT. The results support a dissociation between neuropsychological malingering and exaggeration of psychiatric symptoms in a neuropsychological setting.