Who is exaggerating cognitive impairment and who is not?

This chart review examined the effects of effort on neuropsychological assessment and test performance patterns among genuine and exaggerating patients, with and without neurological findings, as aids to diagnosing symptom exaggeration. The sample consisted of 561 consecutive patients involved in compensation claims. With a flexible neuropsychological test (NPT) battery, the claims were assessed over 2 days. The sample included 303 patients evaluated for traumatic brain injury, 55 patients with neurological disease, and 203 patients assessed for other conditions (eg, depression or chronic pain). An average of 38 ability measures per patient were used to generate an overall NPT domain score. Composite scores were also computed for symptom validity tests, self-report measures of psychiatric symptoms, and memory complaint inventory. Seven NPT cognitive subdomain scores were multiply regressed onto the symptom validity test composite, accounting for 45% of its total variance. Patients were also assigned to Genuine or Exaggerator groups based on symptom validity test performance. The NPT for Exaggerating patients averaged 1.43 standard deviations below that of Genuine patients, suggesting that NPT scores for most Exaggerating patients are underestimates of their true ability. Factor analysis results differed between these groups. As a result, clinicians might avoid falsely identifying genuine patients as exaggerating by incorporating their self-reports of psychiatric symptoms and memory complaints into the diagnostic process.     

A Statistical Interpretive Method for Neuropsychological Test Data

The accurate interpretation of large numbers of neuropsychological tests within a flexible battery approach is a difficult and sometimes controversial process. We present a statistically based method of interpretation (Rohling's Interpretive Method or RIM) and evaluation of neuropsychological data that allows for varying numbers of tests along a varying number of cognitive domains, yet remains psychometrically based. This method requires informed clinical judgment in that the level of confidence for tests, cognitive domains, and global indices are used as the backdrop for interpretive decisions. Specific procedures for use are presented in a systematic, detailed fashion to allow the interested reader to replicate the method. Two case examples are presented: a straightforward case of cerebrovascular insult and a more complicated case of mixed etiology. Examples include a variety of different neuropsychological tests commonly used in a flexible battery approach. A discussion of the practicality, ease of use, and potential limitations of this method are further presented.     

The Life Attitudes Schedule-Short Form: psychometric properties and correlates of adolescent suicide proneness

The goals of the present study were to describe the psychometric properties of the Life Attitudes Schedule-Short Form (LAS-SF) in adolescents and provide criterion and construct validity data, including bivariate and multivariate associations with related risk behaviors. Anonymous questionnaires containing the LAS-SF and related measures were administered to 1,742 high school students in three states. Psychometric properties for LAS-SF items and total score were very good, and the LAS-SF was correlated with almost all of the examined risk behaviors, illustrating the broad range of problems measured by the instrument. LAS-SF total scores were associated with past suicide attempt, even after controlling for the impact of current depression. Clinical and research uses for the LAS-SF are discussed.     

A misleading review of response bias: comment on McGrath, Mitchell, Kim, and Hough (2010)

In the May 2010 issue of Psychological Bulletin, R. E. McGrath, M. Mitchell, B. H. Kim, and L. Hough published an article entitled "Evidence for Response Bias as a Source of Error Variance in Applied Assessment" (pp. 450-470). They argued that response bias indicators used in a variety of settings typically have insufficient data to support such use in everyday clinical practice. Furthermore, they claimed that despite 100 years of research into the use of response bias indicators, "a sufficient justification for [their] use… in applied settings remains elusive" (p. 450). We disagree with McGrath et al.'s conclusions. In fact, we assert that the relevant and voluminous literature that has addressed the issues of response bias substantiates validity of these indicators. In addition, we believe that response bias measures should be used in clinical and research settings on a regular basis. Finally, the empirical evidence for the use of response bias measures is strongest in clinical neuropsychology. We argue that McGrath et al.'s erroneous perspective on response bias measures is a result of 3 errors in their research methodology: (a) inclusion criteria for relevant studies that are too narrow; (b) errors in interpreting results of the empirical research they did include; (c) evidence of a confirmatory bias in selectively citing the literature, as evidence of moderation appears to have been overlooked. Finally, their acknowledging experts in the field who might have highlighted these errors prior to publication may have prevented critiques during the review process.     

Self-Reported Depressive Symptoms Have Minimal Effect on Executive Functioning Performance in Children and Adolescents

The relation between mood and executive functioning in children and adolescents has not been previously reported. This study examined the association between self-reported depressive symptoms in both clinical outpatient and psychiatric inpatient samples to the following measures of executive functioning: the Controlled Oral Word Association Test, Animal Naming, Trail Making Test, and Wisconsin Card Sorting Test. Records from children and adolescents aged 7–17 years old with an IQ > 70 were examined. Data were gathered at either an outpatient neuropsychology clinic (n = 89) or an inpatient psychiatric hospital setting (n = 81). Mood was measured with the Children’s Depression Inventory. Generally, statistical associations between self-reported depressive symptoms and executive functioning were small and non-significant. The variance predicted by mood on measures of executive functioning was minimal (generally less than 2 %) for the total sample, the outpatient group, inpatient group, and a subgroup who endorsed elevated mood symptoms. These results suggest that impaired performance on measures of executive functioning in children and adolescents is minimally related to self-reported depressive symptoms.