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The Detection of Neuropsychological Malingering

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The Detection of Neuropsychological Malingering THE DETECTION OF NEUROPSYCHOLOGICAL MALINGERING Christine D. Liff, B.A., M.S. Dissertation Prepared for the Degree of DOCTOR OF PHILOSOPHY UNIVERSITY OF NORTH TEXAS August 2003 APPROVED: Craig Neumann, Acting Chair Ernest Harrell, Chair, Major Professor, and Chair of the Department of Psychology Kenneth Sewell, Committee Member and Director of Clinical Training James Quinn, Committee Member C. Neal Tate, Dean of the Robert B. Toulouse School of Graduate Studies Liff, Christine D., The Detection of Neuropsychological Malingering. Doctor of Philosophy (Clinical Psychology), August 2003, 163 pp., 24 tables, 25 figures, references, 112 titles. The present study compared the responses of a group of simulating malingerers who were offered a monetary incentive to feign symptoms of a head injury, with the responses of head injured groups both with and without litigation, a forensic parole group, and an honest- responding control group. The following six neuropsychological measures were utilized: Rey 15-Item Memory Test, Controlled Oral Word Association Test, Finger Oscillation Test, WAIS-R Neuropsychological Instrument (Vocabulary, Information, and Similarities subtests), Booklet Category Test, and Wisconsin Card Sorting Test. The statistical concepts of floor effect, performance curve, and magnitude of error were examined. Additionally, the statistical differences in the responses of the five groups were analyzed to determine cutting scores for use in distinguishing malingerers from nonmalingerers. Copyright 2003 by Christine D. Liff ii ACKNOWLEDGMENTS To my grandmother, Elayne, who fostered my sense of adventure and passion for life. If only you could be here to share this with me. To my parents, Leilani and George, who believed in hard work and allowed me autonomy and independence. To my mentors along the way: Bruce, Neil, Shelly, Vi, Ann, Jim, Munro, Anne-Marie, and Pat. You, along with a handful of others, shaped me professionally, leaving me with more than I could ever repay. Most of all, to my son, Evan, who has traveled this journey with me. He was my inspiration when things were difficult and resources lean. Through all the smiles and the tears, those we’ve shared our lives with, and those we’ve left behind, he is my constant, my shining star. I will forever be grateful for the gift his love has given me, and for being so blessed to share even a part of his life. iii TABLE OF CONTENTS ACKNOWLEDGMENTS .............................................................................................................. ii LIST OF TABLES........................................................................................................................ vii LIST OF FIGURES ..................................................................................................................... viii CHAPTER I INTRODUCTION....................................................................................................1 Neuropsychology, Malingering, and the Legal System ............................................................... 2 Classifications and Definitions of Malingering................................................................ 3 Neuropsychological Assessment and Malingering. ..................................................................... 4 Studies Utilizing Neuropsychological Assessment Batteries....................................................... 8 Luria-Nebraska Neuropsychological Battery (LNNB) .................................................... 9 Halstead-Reitan Neuropsychological Battery (HRNB) ................................................. 10 Studies Utilizing Multiple Neuropsychological Assessment Instruments. ................................ 17 The Rey 15-Item Memory Test (RMT) Studies............................................................. 19 Studies Utilizing Individual Neuropsychological Assessment Instruments............................... 24 Finger Oscillation Studies .............................................................................................. 25 Booklet Category Test Studies ....................................................................................... 26 Wisconsin Card Sorting Test Studies............................................................................. 26 Symptom Validity Testing Studies................................................................................. 27 Tests Utilized Specifically for Malingering ................................................................... 30 Summary......................................................................................................................... 31 Guidelines for the Detection of Malingering ............................................................................. 34 Six Specific Strategies Employed to Detect Malingering.............................................. 38 Floor effect................................................................................................................. 38 Performance curve..................................................................................................... 38 Magnitude of error..................................................................................................... 39 Symptom validity testing........................................................................................... 39 Atypical presentation................................................................................................. 41 Psychological sequelae .............................................................................................. 41 The Purpose of this Study........................................................................................................... 42 Estimates of Diagnostic Accuracy.................................................................................. 45 CHAPTER II METHODS ...........................................................................................................48 iv Participants ................................................................................................................................. 48 The Rey 15-Item Memory Test (RMT).......................................................................... 53 Reliability and validity of the RMT .......................................................................... 53 The Controlled Oral Word Association Test (COWA).................................................. 54 Reliability and validity of the COWA....................................................................... 55 Finger Oscillation Test ................................................................................................... 55 Reliability and validity of the Finger Oscillation Test .............................................. 56 The Booklet Category Test (BCT) ................................................................................. 56 Reliability and validity of the BCT ........................................................................... 57 The Wisconsin Card Sorting Test (WCST).................................................................... 59 Reliability and validity of the WCST ........................................................................ 61 Weschler Adult Intelligence Scale-Revised, Neuropsychological Instrument (WAIS-R NI).................................................................................................... 64 Reliability and validity of the WAIS-R NI................................................................ 65 Procedures .................................................................................................................................. 66 Statistical Testing of the Research Hypotheses.......................................................................... 68 Hypothesis One .............................................................................................................. 68 Hypothesis Two.............................................................................................................. 69 Hypothesis Three............................................................................................................ 71 Hypothesis Four.............................................................................................................. 71 CHAPTER III RESULTS............................................................................................................73 Sample Characteristics ............................................................................................................... 73 Between-Group Differences on Demographics.......................................................................... 75 Hypothesis One Inferential Statistics ......................................................................................... 77 Hypothesis Two Inferential Statistics......................................................................................... 92 Hypothesis Three Inferential Statistics....................................................................................... 98 Hypothesis Four Inferential Statistics ........................................................................................ 99 Debriefing Questionnaire ......................................................................................................... 100 CHAPTER IV DISCUSSION....................................................................................................102 Cutoff Scores and Hit Rates ....................................................................................................
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