NeuroRehabilitation - Volume 16, issue 4

Authors: Martelli, Michael F. | Zasler, Nathan D.

Article Type: Editorial

DOI: 10.3233/NRE-2001-16401

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 195-197, 2001

Authors: Sbordone, Robert J.

Article Type: Research Article

Abstract: While neuropsychological tests have been designed to identify cognitive impairments stemming from a brain insult and their severity, the vast majority of these tests were never designed to predict how these patients were likely to function in real-world settings, live independently, return to work, or maintain competitive employment. No one specific neuropsychological test or measure can accurately predict how an individual who has sustained a brain insult will function in everyday or vocational settings. Predictions based on neuropsychological test data tend to be more accurate if the particular tasks utilized during testing closely match or simulate the individual's everyday and …vocational demands. Predicting an individual's vocational potential also requires a careful assessment of his or her work and medical history, injury characteristics, emotional and behavioral functioning, motivation to return to work, and family circumstances. Show more

Keywords: neuropsychological testing, ecological validity, brain damage

DOI: 10.3233/NRE-2001-16402

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 199-201, 2001

Authors: Senior, Graeme | Douglas, Lucille

Article Type: Research Article

Abstract: The MMPI-2 enjoys widespread popularity in the psychological assessment of personal injury claimants, in part due to its long history, massive research literature, strong empirical basis, and the availability of commercial interpretative and scoring services. However, the relative paucity of studies examining the forensic role of the MMPI-2, raises concerns about the applicability of traditional interpretative guidelines in the medicolegal arena. This paper analyses MMPI-2 protocols of 2080 cases derived from a forensic psychiatric practice in Brisbane, Australia. The data presented here challenges these traditional MMPI-2 interpretations and calls into question assumptions and commonly employed techniques when applied in this …setting. In particular, the validity of codetype-based interpretations, the role the MMPI-2 plays in differential diagnosis, and assumptions regarding diagnostically-specific patterns on the test are challenged. MMPI-2 interpretative cookbooks, computer report-writers, adherence to the intent of the test-developers, and appeals to authority are inadequate substitutes for empirical accuracy, and an active hypothesis-testing interpretative approach, based upon setting-specific base-rate data, is recommended. Show more

Keywords: MMPI-2, differential diagnosis, codetype analysis

DOI: 10.3233/NRE-2001-16403

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 203-213, 2001

Authors: Gouvier, Wm. Drew

Article Type: Research Article

Abstract: The core constructs of psychological assessment, reliability and validity, are shown to be incomplete and lacking whenever base rates for the conditions under evaluation skew markedly from 50/50. Under such circumstances, base rate information can exert a greater influence on diagnostic accuracy that is typically recognized among practitioners. The influence of base rates is so profound, that conclusions based on reliable and valid test data are often, more probably than not, wrong! This paper outlines our historical understanding of the “base rate fallacy”, and offers explanations for its persistence in the practice of diagnostic psychology. Recommendations for self-monitoring and policing …of our profession are offered, in order that neuropsychology might improve its diagnostic accuracy at a rate more comparable to the progress made in similar fields in medicine. Show more

Keywords: reliability, validity, effectiveness, base rates, diagnostic accuracy, error types

DOI: 10.3233/NRE-2001-16404

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 215-219, 2001

Authors: Williams, Arthur D.

Article Type: Research Article

Abstract: This article describes measurement and norming problems with commonly used neuropsychological tests. Test standards regarding differential diagnoses, validity and reliability, the need for manuals, standardized administration, screening, and research versions are discussed. Further development of reliability, validity, sensitivity and specificity is needed for many tests.

Keywords: neuropsychological tests, standardization, administration, screening

DOI: 10.3233/NRE-2001-16405

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 221-224, 2001

Authors: Nicholson, Keith | Martelli, Michael F. | Zasler, Nathan D.

Article Type: Research Article

Abstract: There is increasing evidence that pain and related problems (e.g., affective distress, sleep disturbance, medication use) can interfere with cognitive performance and confound the interpretation of neuropsychological test results. This may be of particular concern in cases of the persistent post-concussive syndrome where headache is the primary problem. Such effects can be pronounced, obscuring the effects associated with mild or even much more significant brain injury. However, it remains unclear what specific chronic or acute pain experiences, in what individuals, with or without which associated problems, will actually result in particular performance deficits. Whereas pain may disrupt brain function, this …is likely to be temporary and not indicative of permanent impairment of neuropsychological function. Further study of this important topic is warranted. Show more

DOI: 10.3233/NRE-2001-16406

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 225-230, 2001

Authors: Green, Paul

Article Type: Research Article

Abstract: Examining the validity of test results using specialised methods is still a relatively new venture and many different approaches are taken to the same task. This paper discusses some of the reasons why discrepant results and differing conclusions may be arrived at by clinicians or researchers, depending on their theoretical and practical choices. These choices include whether to test for effort, what methods to use, how to employ effort tests, what failure criteria to apply and how to interpret individual results. Equally important is the decision about whether or not to employ effort testing to remove error from data in …group research studies. No concensus has yet been reached on the need for systematic effort testing in group studies but there are indications that it should be a serious consideration because controlling for invalid data can lead to altered conclusions. Show more

DOI: 10.3233/NRE-2001-16407

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 231-236, 2001

Authors: Green, Paul | Iverson, Grant L.

Article Type: Research Article

Abstract: The purpose of this study was to examine the relationship between exaggeration and scores on a test of olfactory discrimination in patients being assessed in connection with a claim for financial benefits. Participants were 448 patients referred to a private practice in Edmonton, Alberta, Canada for psychological or neuropsychological assessment, related to evaluation of impairment and disability resulting from a work-related or non-work related accident. All patients were involved in some form of compensation claim at the time of their evaluation. All patients completed two tests designed to detect exaggerated cognitive deficits, the Computerized Assessment of Response Bias (CARB) and …the Word Memory Test (WMT) as part of their evaluation. The diagnostic groups included 322 head injury cases, varying from very minor to very severe. Normative data for the smell test were derived from 126 patients with orthopedic injuries who passed both the CARB and the WMT. Patients with more severe traumatic brain injuries were 10-12 times more likely to have olfactory deficits than persons with trivial to mild head injuries. In a subgroup of patients who failed either the CARB or the WMT, there was no relationship between injury severity and total scores on the smell test. Therefore, the dose-response relationship between brain injury severity and olfactory deficits is severely attenuated when patients who are probably exaggerating their cognitive deficits are included in the analyses. Those patients with trivial to mild head injuries who demonstrated adequate effort on both the CARB and the WMT were no more likely to show olfactory deficits than the non-head-injured orthopedic control subjects. Therefore, anosmia following mild traumatic brain injury should not be concluded from self-reports or from tests of smell unless tests of effort have been passed. Effort should also be controlled in group studies of olfaction. Show more

Keywords: olfaction, neuropsychological assessment, brain injury, anosmia

DOI: 10.3233/NRE-2001-16408

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 237-243, 2001

Authors: Vanderploeg, Rodney D. | Curtiss, Glenn

Article Type: Research Article

Abstract: Consideration of symptom exaggeration or overt malingering is of particular importance in assessment of alleged mild head trauma and other mild or questionable personal injury situations. Validity is the extent to which tests assess what they were designed to measure. The determination of invalidity is part of the overall neuropsychological interpretation process. In neuropsychology a line of validity assessment research has developed, leading to three general approaches to validity and/or malingering assessment: (a) symptom validity measures, (b) invalid patterns of performance on clinical neuropsychological measures, and (c) concomitant extra-test behavioral information or observations. In each case some aspect of behavior …is compared to an external standard or to other intra-subject behavior. Inconsistencies and discrepant comparisons are cause for validity concerns. These approaches are described and recommendations are provided based on the extant literature. However, validity assessment is difficult and at times ambiguous in part because real and feigned deficits are not mutually exclusive. In some clinical situations the most that can be said about an invalid performance is that it is not indicative of the true neurobehavioral capabilities of the person being evaluated, and is not consistent with the presumed etiologic event. Show more

Keywords: malingering, dissimulation, brain injury, litigation

DOI: 10.3233/NRE-2001-16409

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 245-251, 2001

Authors: Colby, Faulder

Article Type: Research Article

Abstract: The binomial distribution is often, but prematurely, rejected as a tool for assessing effort. This study extended previous research using published clinical and computer-generated pseudo subject data for the Test of Memory Malingering (TOMM) . The efficiencies of eight cut points based upon inverse binomial distribution functions were compared with the cut point recommended in the test manual for making correct classifications, and a new statistic, the total number of errors, was also compared with the test manual cut point. Repeated measures, multivariate, and univariate ANOVAs, Bonferroni-corrected post-hoc t-tests, and normal curve density functions were employed to assess the homogeneity …of groups within experimental conditions. Based upon these analyses, changes were recommended in the decision rules for the TOMM , and strategies for improving the norms for the TOMM and for neuropsychological assessment instruments, generally, were discussed. Show more

Keywords: malingering, effort, motivation, neuropsychological, assessment, TOMM, binomial

DOI: 10.3233/NRE-2001-16410

Citation: NeuroRehabilitation, vol. 16, no. 4, pp. 253-265, 2001