Symptom validity assessment in European countries: Development and state of the art

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.

Failing Performance Validity Cutoffs on the Boston Naming Test (BNT) Is Specific, but Insensitive to Non-Credible Responding

This study was designed to examine alternative validity cutoffs on the Boston Naming Test (BNT).Archival data were collected from 206 adults assessed in a medicolegal setting following a motor vehicle collision. Classification accuracy was evaluated against three criterion PVTs.The first cutoff to achieve minimum specificity (.87-.88) was T ≤ 35, at .33-.45 sensitivity. T ≤ 33 improved specificity (.92-.93) at .24-.34 sensitivity. BNT validity cutoffs correctly classified 67-85% of the sample. Failing the BNT was unrelated to self-reported emotional distress. Although constrained by its low sensitivity, the BNT remains a useful embedded PVT.

PediaTrac V.3.0 protocol: a prospective, longitudinal study of the development and validation of a web-based tool to measure and track infant and toddler development from birth through 18 months

INTRODUCTION

The need for an efficient, low-cost, comprehensive measure to track infant/toddler development and treatment outcomes is critical, given the importance of early detection and monitoring. This manuscript describes the protocol for the development and testing of a novel measure, PediaTrac, that collects longitudinal, prospective, multidomain data from parents/caregivers to characterise infant/toddler developmental trajectories in term and preterm infants. PediaTrac, a web-based measure, has the potential to become the standard method for monitoring development and detecting risk in infancy and toddlerhood.

METHODS AND ANALYSES

Using a multisite, prospective design, primarcaregivers will complete PediaTrac V.3.0, a survey tool that queries core domains of early development, including feeding/eating/elimination, sleep, sensorimotor, social/sensory information processing, social/communication/cognition and early relational health. Information also will be obtained about demographic, medical and environmental factors and embedded response bias indices are being developed as part of the measure. Using an approach that systematically measures infant/toddler developmental domains during a schedule that corresponds to well-child visits (newborn, 2, 4, 6, 9, 12, 15, 18 months), we will assess 360 caregiver/term infant dyads and 240 caregiver/preterm infant dyads (gestational age <37 weeks). Parameter estimates of our items and latent traits (eg, sensorimotor) will be estimated by theta using item response theory-graded response modelling. Participants also will complete legacy (ie, established) measures of development and caregiver health and functioning, used to provide evidence for construct (discriminant) validity. Predictive validity will be evaluated by examining relationships between the PediaTrac domains and the legacy measures in the total sample and in a subsample of 100 participants who will undergo a neurodevelopmental assessment at 24 months of age.

ETHICS AND DISSEMINATION

This investigation has single Institutional Review Board (IRB) multisite approval from the University of Michigan (IRB HUM00151584). The results will be presented at prominent conferences and published in peer-reviewed scientific journals.

An Inventory of Problems-29 (IOP-29) study investigating feigned schizophrenia and random responding in a British community sample

Compared to other Western countries, malingering research is still relatively scarce in the United Kingdom, partly because only a few brief and easy-to-use symptom validity tests (SVTs) have been validated for use with British test-takers. This online study examined the validity of the Inventory of Problems-29 (IOP-29) in detecting feigned schizophrenia and random responding in 151 British volunteers. Each participant took three IOP-29 test administrations: (a) responding honestly; (b) pretending to suffer from schizophrenia; and (c) responding at random. Additionally, they also responded to a schizotypy measure (O-LIFE) under standard instruction. The IOP-29's feigning scale (FDS) showed excellent validity in discriminating honest responding from feigned schizophrenia (AUC = .99), and its classification accuracy was not significantly affected by the presence of schizotypal traits. Additionally, a recently introduced IOP-29 scale aimed at detecting random responding (RRS) demonstrated very promising results.

Knowledge of Depression and Malingering: An Exploratory Investigation

Malingering mental disorder for financial compensation can offer substantial rewards to those willing to do so. A recent review of UK medico-legal experts' practices for detecting claimants evidenced that they are not well equipped to detect those that do. This is not surprising, considering that very little is known regarding why individuals opt to malinger. A potential construct which may influence an individual's choice to malinger is their knowledge of the disorder, and when one considers the high levels of depression literacy within the UK, it is imperative that this hypothesis is investigated. A brief depression knowledge scale was devised and administered to undergraduate students (N = 155) alongside a series of questions exploring how likely participants were to malinger in both workplace stress and claiming for benefit vignettes. Depression knowledge did not affect the likelihood of engaging in any malingering strategy in either the workplace stress vignettes or the benefit claimant vignettes. Differences were found between the two vignettes providing evidence for the context-specific nature of malingering, and an individual's previous mental disorder was also influential.

Performance and Symptom Validity Assessment in Patients with Apathy and Cognitive Impairment

OBJECTIVE

Performance and symptom validity tests (PVTs and SVTs) measure the credibility of the assessment results. Cognitive impairment and apathy potentially interfere with validity test performance and may thus lead to an incorrect (i.e., false-positive) classification of the patient's scores as non-credible. The study aimed at examining the false-positive rate of three validity tests in patients with cognitive impairment and apathy.

METHODS

A cross-sectional, comparative study was performed in 56 patients with dementia, 41 patients with mild cognitive impairment, and 41 patients with Parkinson's disease. Two PVTs - the Test of Memory Malingering (TOMM) and the Dot Counting Test (DCT) - and one SVT - the Structured Inventory of Malingered Symptomatology (SIMS) - were administered. Apathy was measured with the Apathy Evaluation Scale, and severity of cognitive impairment with the Mini Mental State Examination.

RESULTS

The failure rate was 13.7% for the TOMM, 23.8% for the DCT, and 12.5% for the SIMS. Of the patients with data on all three tests (n = 105), 13.5% failed one test, 2.9% failed two tests, and none failed all three. Failing the PVTs was associated with cognitive impairment, but not with apathy. Failing the SVT was related to apathy, but not to cognitive impairment.

CONCLUSIONS

In patients with cognitive impairment or apathy, failing one validity test is not uncommon. Validity tests are differentially sensitive to cognitive impairment and apathy. However, the rule that at least two validity tests should be failed to identify non-credibility seemed to ensure a high percentage of correct classification of credibility.

The Psychological Effects of Road Traffic Accidents (RTAs): An Exploration of a United Kingdom Medico-Legal Examiner's Career of RTA Assessments

Around 20 to 50 million people are injured as a result of a road traffic accident (RTA) each year throughout the world. In the United Kingdom there have been considerable efforts made to review the assessment of whiplash claimants following RTAs due to the perceived level of fraud. However, very little has been done with regards to assessments for mental disorder; this article seeks to investigate how such assessments are undertaken. Data originating from one clinical forensic psychologist's practice (N = 305) are examined to provide an insight into the assessment of mental disorder in the medico-legal arena in the United Kingdom, building upon previous research. Many important findings emerged from this analysis including a complicated relationship between the diagnosis of mental disorder and the gender of the claimant. In addition, this article provides detailed normative data using the Symptom Checklist 90 Revised, the Impact of Events Scale, and the Beck Depression Inventory.

An International Perspective on Feigned Mental Disabilities: Conceptual Issues and Continuing Controversies

In forensic contexts, an increased prevalence of feigned symptom presentations should be expected, although it will probably vary by the context and specific forensic issue. Forensic experts should examine this possibility proactively while maintaining a balanced perspective that actively considers clinical data for both feigning and genuine responding. Psychological measures and standardized methods developed for feigning and other response styles can facilitate these often complex determinations. The current article provides an international perspective on the issue of feigned mental disabilities. In particular, important conceptual issues are discussed, such as the categorical versus dimensional approaches to feigning, and the advisability of well-defined rather than single-point cut scores for accuracy in clinical decision-making. Salient problems of differential diagnosis include a spectrum from malingering and factitious disorders to somatoform and conversion disorders. In rendering these important diagnostic distinctions, the questions of motivations and intentions remain key. However, the establishment of motivation cannot be facilely assumed from the context. Instead, forensic psychologists and psychiatrists bear the professional burden of carefully evaluating motivation and recognizing the clinical reality that sometimes the motivation in especially challenging cases may not be fully determined. Copyright © 2017 John Wiley & Sons, Ltd.