Lowered cutoffs to reduce false positives on the Word Memory Test.

OBJECTIVE: To adjust the decision criterion for the Word Memory Test (WMT, Green, 2003) to minimize the frequency of false positives. METHOD: Archival data were combined into a database (n = 3,210) to examine the best cut score for the WMT. We compared results based on the original scoring rules and those based on adjusted scoring rules using a criterion based on 16 performance validity tests (PVTs) exclusive of the WMT. Cutoffs based on peer-reviewed publications and test manuals were used. The resulting PVT composite was considered the best estimate of validity status. We focused on a specificity of .90 with a false-positive rate of less than .10 across multiple samples. RESULTS: Each examinee was administered the WMT, as well as on average 5.5 (SD = 2.5) other PVTs. Based on the original scoring rules of the WMT, 31.8% of examinees failed. Using a single failure on the criterion PVT (C-PVT), the base rate of failure was 45.9%. When requiring two or more failures on the C-PVT, the failure rate dropped to 22.8%. Applying a contingency analysis (i.e., X2) to the two failures model on the C-PVT measure and using the original rules for the WMT resulted in only 65.3% agreement. However, using our adjusted rules for the WMT, which consisted of relying on only the IR and DR WMT subtest scores with a cutoff of 77.5%, agreement between the adjusted and the C-PVT criterion equaled 80.8%, for an improvement of 12.1% identified. The adjustmeny resulted in a 49.2% reduction in false positives while preserving a sensitivity of 53.6%. The specificity for the new rules was 88.8%, for a false positive rate of 11.2%. CONCLUSIONS: Results supported lowering of the cut score for correct responding from 82.5% to 77.5% correct. We also recommend discontinuing the use of the Consistency subtest score in the determination of WMT failure.

An Executive Functioning Composite Does Not Moderate the Relationship Between Combat Exposure and Posttraumatic Stress Disorder Symptom Clusters.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is prevalent among U.S. combat Veterans, and associated with poor health and wellbeing. As combat experiences are likely to significantly modify self-, other-, and society-oriented cognitions and heighten risk for PTSD, examination of related cognitive processes may yield new treatment strategies. The cognitive model of PTSD suggests that persistent threat perceptions contribute to symptom worsening. Thus, cognitive processes of shifting perspectives or generating novel interpretations may be particularly relevant to lessen PTSD symptoms. This cross-sectional study examined executive functioning as a moderator to the relationship between combat exposure and PTSD symptom clusters among post-9/11 Veterans. METHOD: Data from 168 Veterans were drawn from a larger study examining post-deployment mental health and cognitive function. An executive functioning composite derived from Wisconsin Card Sorting Test Perseveration Errors, WAIS-III Similarities, Trail Making Test B, and Stroop Color-Word Inhibition scores was computed. Path analysis was used to test the moderation model. RESULTS: After accounting for age, sex, and estimated premorbid functioning, results indicated that combat exposure was associated with all symptom clusters on the PTSD Checklist-Military. Executive functioning was not significantly associated with the PTSD symptom clusters and did not moderate the relationship between combat exposure and any of the PTSD symptom clusters. CONCLUSIONS: Combat exposure is an important dimension of risk related to PTSD in Veterans that warrants regular screening. Moderation by executive functioning was not observed despite theoretical support. Future work could test methodological and sampling reasons for this finding to determine if theoretical adjustment is necessary.

Detecting feigned ADHD in college students using the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF).

Objective: To investigate the utility of the validity scales of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) for detecting feigned Attention-Deficit Hyperreactivity Disorder (ADHD), we utilized a simulation design. Method: We examined group differences across the Restructured Clinical (RC) and validity scales as well as the classification ability of the validity scales across three cut scores. Analyses were conducted across five simulation groups (N = 177) and a standard instruction group (N = 32). Results: Across most of the RC and validity scales, those feigning ADHD produced significantly higher scores than the standard instruction group, but generally no significant differences between the feigning groups were demonstrated. The most promising scales for detecting feigned ADHD were F-r, Fp-r, and Fs at cut scores in the 70 T to 80 T range, respectively. Conclusions: Results support the use of the MMPI-2-RF in ADHD evaluations with scores on F-r, Fs, and Fp-r being particularly useful in detecting feigned ADHD in college students. However, there was no evidence to support the feigning of distinct ADHD symptoms presentations.

Exploring the Specificity, Synergy, and Durability of Auditory and Visual Computer Gameplay Transfer Effects in Healthy Older Adults.

OBJECTIVES: To determine whether auditory and visual computer games yield transfer effects that (a) are modality-specific to verbal memory (auditory stimulus presentation) and visual-processing tests, (b) affect working memory and processing speed, (c) are synergistic for combined game-type play, and (d) are durable. METHOD: A Pilot Study (N = 44) assessed visual transfer effects in a two-group pre-post design. The Main Study (N = 151) employed a 2 (visual games: yes, no) × 2 (auditory games: yes, no) × 3 (test session: pretest, post-test, follow-up) design, allowing different training groups to act as active controls for each other. Neuropsychological test scores were aggregated into verbal-memory (auditory presentation), visual-processing, working-memory, and processing-speed indexes. RESULTS: Visual-processing and working-memory pre-post-training change scores were differentially modulated across the four gameplay groups in the main sample, demonstrating transfer effects differing across both active- and passive-control groups. Visual training yielded modality-specific transfer effects in both samples, transfer to working memory in the main sample, and transfer to processing speed in the pilot sample. There were no comparable transfer effects for auditory training. Combined-visual-and-auditory training failed to yield synergistic effects or any significant transfer effects. Visual-processing transfer effects remained significant at follow-up. DISCUSSION: Visual and auditory games differentially modulated transfer effects. Domain-specific visual transfer effects were found at post-test and were durable at follow-up. Visual gameplay holds potential to ameliorate age-related cognitive decline in visual cognition.

Predictors of Financial Capacity in Young Adults.

OBJECTIVE: To examine several predictors of financial capacity as assessed via the Independent Living Scales Money Management (ILS-MM) subtest in a regression correlational design. METHOD: One hundred and five college students were administered measures of financial literacy and financial experience, as well as multiple neuropsychological measures assessing language, processing speed, executive functioning, and arithmetic. Using hierarchical regression analyses, we sought to predict performance on the two subscales of the ILS-MM-Problem Solving and Performance/Information. The former assesses financial knowledge (e.g., defining financial terms such as health insurance) whereas the latter assesses financial abilities (e.g., computing a financial balance). RESULTS: After controlling for demographic variables, financial literacy and experience predicted the Problem Solving subscale, but not the Performance subscale. Neuropsychological measures did not account for additional variance. In contrast, after controlling for demographic variables and financial literacy and financial experience, neuropsychological measures predicted the Performance but not the Problem Solving subscale. The key predictor was the Arithmetic subtest of the Wide Range Achievement Test4, which is not surprising given the mathematical demands of the task. Measures of executive functioning were not related to this measure. CONCLUSIONS: Financial capacity is a broad construct, encompassing many financial abilities and concepts. To predict these, a variety of measures is necessary: financial literacy and experience predict knowledge-based items, whereas neuropsychological measures, especially arithmetic, predict performance-based items. Clinical and research implications of these findings are discussed as well as directions for future investigation.

Evaluating Potential Guardians for Adults Adjudicated Incompetent.

Despite the considerable interest from psychology and law in how to assess and conceptualized competency issues, relatively little has been written about guardianship, particularly how to best evaluate guardianship candidates. This is problematic because a guardian is assigned once an individual is adjudicated incompetent and decision-making about this is difficult in some cases. As psychologists have much to offer the court in making recommendations about a suitable guardian, the purpose of this article is to provide specific recommendation in domains to assess in an interview with a potential guardian. Domains that should be assessed include the following: relationship with proposed ward, knowledge and insight about proposed ward, guardianship plans, decision-making style, and suitability for guardianship. Recommendations are also provided for especially difficult cases such as when working with families in conflict, the presence of undue influence, and when a family member or friend is pitted against a disinterested public agency.

Diagnostic Differences and Demographic Predictors of Respondents Adjudicated Civilly Incompetent Versus Competent.

The purpose of this study was to determine if diagnostic and demographic variables predict civil competency adjudications, a topic that has received scant research attention. Respondents (i.e., individuals alleged to be incompetent) were evaluated by a licensed psychologist to assist the court in civil competency and possible guardianship determination. Prior research using some of the same participants demonstrated select differences on activities of daily living between these groups (Quickel & Demakis, ), but the current set of analyses was not conducted. The current study included 107 competency evaluations in Mecklenburg County North Carolina and, at conclusion of the case, the public record of the adjudication was obtained. Based on prior legal theorizing in related criminal areas--focused on discrimination of individuals with mental illness--we predicted that cases involving respondents with psychiatric diagnoses would be likely to be overrepresented in those referred for evaluation as well as those subsequently adjudicated incompetent. A series of analyses indicated no statistical differences between competency groups (psychiatric/substance abuse, neurological, both psychiatric and neurological, and intellectually disabled). In a series of exploratory logistic regression analyses, we found that respondents who were single versus in a relationship and those not living at home versus living at home were significantly more likely to be adjudicated incompetent, even after controlling for difference in activities of daily living. There were no differences in incompetency adjudication by age, education, gender, race, or relationship status. Results are discussed in terms of implications for individuals with mental illness in incompetency hearings, as well as specific issues for psychologists evaluating a broad range of respondents.

Predictive validity of the MMPI-2 among female offenders in a residential treatment program.

This study investigated the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) validity, clinical, restructured clinical, supplementary, and content scales in a female correctional population. The study used archival data for a final sample of 116 women who had been evaluated for acceptance into a residential rehabilitative treatment program for nonviolent female offenders in North Carolina. MMPI-2 scale elevations are reported and assessed for predictive validity in relation to treatment success, as measured by treatment attendance and graduation status. In relation to predictive validity, logistic regression analyses revealed that elevations on Scales FRS (Fears) and R (Repression) differentiated women who attended the program from women who did not. Elevations on Scales 4, DEP (Depression), Re (Responsibility), and AAS (Addiction Admission Scale) differentiated women who graduated the program from women who did not. Implications for the rehabilitation of female offenders, as well as limitations of this exploratory study, are discussed.

The Independent Living Scales in civil competency evaluations: initial findings and prediction of competency adjudication.

We address a gap in the literature on civil competency by examining characteristics of those who undergo civil competency evaluations and how well Managing Money and Health and Safety subscales of the Independent Living Scales (ILS) predict legal competency adjudications. We were also interested whether these subscales are more accurate in making such predictions than the Mini-Mental State Examination and Trail-Making Test, Parts A and B, well-known measures of neuropsychological functioning. Actual legal competency decisions were obtained from public court records on 71 individuals with either mental retardation/borderline intellectual functioning (MR/BIF) or psychiatric, neurological, or combined psychiatric or neurological diagnoses. We found that those with neurological diagnoses performed significantly better on the Trail-Making Test, Part A, than the MR/BIF and combined neurological and psychiatric groups, and they demonstrated trends in the same direction for other measures. Both ILS subscales performed better than the cognitive measures, in terms of both hit rate and predictive value, in predicting ultimate judicial decision-making about competency. These findings are particularly relevant for clinicians who must decide what measures to include in an assessment battery in civil competency evaluations.

A meta-analysis of neuropsychological outcome after mild traumatic brain injury: re-analyses and reconsiderations of Binder et al. (1997), Frencham et al. (2005), and Pertab et al. (2009).

The meta-analytic findings of Binder et al. (1997) and Frencham et al. (2005) showed that the neuropsychological effect of mild traumatic brain injury (mTBI) was negligible in adults by 3 months post injury. Pertab et al. (2009) reported that verbal paired associates, coding tasks, and digit span yielded significant differences between mTBI and control groups. We re-analyzed data from the 25 studies used in the prior meta-analyses, correcting statistical and methodological limitations of previous efforts, and analyzed the chronicity data by discrete epochs. Three months post injury the effect size of -0.07 was not statistically different from zero and similar to that which has been found in several other meta-analyses (Belanger et al., 2005; Schretlen & Shapiro, 2003). The effect size 7 days post injury was -0.39. The effect of mTBI immediately post injury was largest on Verbal and Visual Memory domains. However, 3 months post injury all domains improved to show non-significant effect sizes. These findings indicate that mTBI has an initial small effect on neuropsychological functioning that dissipates quickly. The evidence of recovery in the present meta-analysis is consistent with previous conclusions of both Binder et al. and Frencham et al. Our findings may not apply to people with a history of multiple concussions or complicated mTBIs.

Prediction of depression and anxiety 1 year after moderate-severe traumatic brain injury.

This study examined three scales of the Personality Assessment Inventory (PAI; Anxiety, Anxiety-Related Disorders, and Depression) in 88 participants 1 year after they suffered a moderate-severe traumatic brain injury (TBI). Participants were all enrolled in the federally funded Traumatic Brain Injury Model System project at Carolinas Rehabilitation. The following variables were assessed at the time of injury: age, sex, employment and marital status, and length of loss of consciousness. Disability status, using the Disability Rating Scale (DRS), was assessed at the time of discharge from the rehabilitation hospital. A series of three linear regression analyses found that these variables significantly predicted scores on the Anxiety and Anxiety-Related Disorders scales, which accounted for 14% and 17.7% of the variance, respectively. The variables did not significantly predict scores on the Depression scale. Within each regression analysis, DRS was consistently and negatively related to each PAI scale, such that greater disability was associated with better psychological functioning. Such seemingly paradoxical findings are discussed in terms of anosognosia or poor awareness of psychological functioning among those with greater disability 1 year after TBI.

Rated cognition in nursing home residents with multiple sclerosis: cross-sectional and longitudinal analyses.

PURPOSE: To examine cognitive change in nursing home residents with multiple sclerosis (MS) over the first year of a nursing home stay and to predict cognition functioning in these residents at admission and the 1-year annual assessment. METHOD: In the first part of this study, the cognitive functioning of nursing home residents with MS (n = 1890) and without MS (n = 22,985) were compared. In the second part, demographic and other variables were used to predict cognition at the admission and 1-year annual assessment for MS residents. RESULTS: Nursing home residents with MS had better cognitive functioning than residents without MS at admission and 1 year later. Regression analyses demonstrated that higher education and pain predicted higher Minimum Data Set Cognition Scale (MDS-Cog) at admission and at 1 year later, but poorer activities of daily living predicted worse MDS-Cog at admission and 1 year later. For the longitudinal analysis, MDS-Cog at the admission assessment was an independent predictor of MDS-Cog scores at the 1-year annual assessment. CONCLUSIONS: Nursing home residents with MS have significantly better cognitive functioning than non-MS residents and, over the first year of a nursing home stay, higher education and pain, but lower activities of daily living, predict poorer cognitive functioning.

Updated meta-analysis of the MMPI-2 symptom validity scale (FBS): verified utility in forensic practice.

Clinical research interest in the symptom reporting validity scale currently known as the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) Symptom Validity Scale (FBS) has continued to be strong, with multiple new publications annually in peer-reviewed journals that publish psychological and neuropsychological assessment research. Related to this growth in relevant literature, the present study was conducted to update the Nelson, Sweet, and Demakis (2006b) FBS meta-analysis. A total of 83 FBS studies (43 new studies) were identified, and 32 (38.5%) met inclusion criteria. Analyses were conducted on a pooled sample of 2218 over-reporting and 3123 comparison participants. Large omnibus effect sizes were observed for FBS, Obvious-Subtle (O-S), and the Dissimulation Scale-Revised (Dsr2) scales. Moderate effect sizes were observed for the following scales: Back Infrequency (Fb), Gough's F-K, Infrequency (F), Infrequency Psychopathology (Fp), and Dissimulation (Ds2). Moderator analyses illustrate that relative to the F-family scales, FBS exhibited larger effect sizes when (1) effort is known to be insufficient and (2) evaluation is conducted in the context of traumatic brain injury. Overall, current results summarize an extensive literature that continues to support use of FBS in forensic neuropsychology practice.

Untreated mild traumatic brain injury in a young adult population.

The current study was conducted to determine (a) the demographic and injury characteristics of individuals who did not receive treatment for mild brain injury and (b) the reasons these individuals do not receive or seek treatment. In a large sample of undergraduate students initially surveyed via an on-line questionnaire (n = 1,853), 35% of those who responded to a subsequent survey acknowledged that they had experienced at least one mild traumatic brain injury (TBI) for which they were not treated. Compared with those who were treated for each TBI, those who were untreated were more likely to be men and were less likely to report persisting symptoms 3 months after the injury. There were no differences in demographics or injury characteristics (e.g., length of time unconscious) between groups. Of those with an untreated TBI, the most common reasons for not seeking treatment were that the symptoms resolved quickly and that they were neither bothersome nor disruptive. Findings are discussed in terms of research on recovery from mild TBI.

Bowden, shores, & Mathias (2006): failure to replicate or just failure to notice. Does effort still account for more variance in neuropsychological test scores than TBI severity?

Several studies have reported that traumatic brain injury (TBI) has a smaller effect on neuropsychological test scores, in contrast to the large effect of poor effort on test performance. Consequently, many authors have concluded that effort needs to be measured routinely and that it is necessary to control for poor effort when measuring the effects of brain disease or injury on performance. Recently, however, Bowden, Shores, and Mathias (2006) have challenged these notions. They argued that the Immediate Recognition subtest of the Word Memory Test (Green & Flaro, 2003), an effort measure, is another verbal memory test rather than a measure of cognitive effort. In this study we re-examine the data from Bowden et al. (2006) and Green, Rohling, Lees-Haley, and Allen (2001) to identify differences between the two studies that might account for their contradictory conclusions. In both sets of data, reanalysis showed that effort explains approximately five times more of the variance in composite neuropsychological test scores than TBI severity. Importantly, scores on the Word Memory Test-Immediate Recognition (WMT-IR) were not correlated with measures of TBI severity, and were not found to correlate with major variables known to be measuring ability (e.g., years of education). These findings challenge the conclusions offered by Bowden and colleagues (2006).

A longitudinal study of cognition in nursing home residents with multiple sclerosis.

PURPOSE: Examine cognitive change in nursing home residents with multiple sclerosis (MS) over the first 4 years of their nursing home stay. METHOD: Nine hundred and twenty-four individuals with MS in nursing homes were longitudinally studied. Of these, 121 had MS but no psychiatric or neurological co-morbidities, 169 had MS plus another neurological disorder (MS-Neuro), 269 had MS plus a psychiatric disorder (MS-Psych) and 365 had MS plus both psychiatric and neurological disorders (MS-Comb). Data were obtained from a large government data-set, the minimum data set (MDS), and cognition was rated on the MDS-Cognition Scale. RESULTS: Data were analysed using a mixed-model ANOVA with a repeated factor of time and a fixed factor Group. We found a significant time effect with declines in cognition between each assessment, except 2000 and 2001, and a significant group effect so that the MS-Neuro and the MS-Comb groups had worse cognition than the MS-Psyc and the MS groups. A significant time x group interaction indicated differences in how the groups declined over time. CONCLUSIONS: Over the first 4 years of a nursing home stay, cognition deteriorates in individuals with MS. Though there are not different rates of decline, residents with MS-Neuro and MS-Comb perform worse than residents with MS or MS-Psyc.

The effect of failure on cognitive and psychological symptom validity tests in litigants with symptoms of post-traumatic stress disorder.

This study examined the influence of performance on cognitive and psychological symptom validity tests on neuropsychological and psychological test performance in claimants evaluated in a medico-legal context (N = 301) with symptoms of PTSD. A second purpose of this study was to examine the influence of the severity of PTSD symptoms on cognitive test performance after excluding patients who failed to put forth adequate best effort and who exaggerated psychiatric symptoms. Patients were administered a battery of neuropsychological measures that were aggregated into a composite measure, the Cognitive-Test Battery Mean (C-TBM). Patients were also administered a battery of psychological tests that were aggregated into another composite measure, the Psychological-Test Battery Mean (P-TBM). We found that failure on cognitive symptom validity tests was associated with significantly poorer neuropsychological functioning, but there was not a significant effect on psychological symptoms. Conversely, failure on psychological symptom validity tests was associated with higher levels of psychopathology, but there was not a significant effect on cognitive ability. Finally, once patients were screened for adequate effort and genuine symptom reporting, the severity of PTSD symptoms did not appear to influence cognitive ability. This is the first study that assessed both types of symptom validity testing in PTSD claimants, which is important given that previous literature has demonstrated cognitive impairment in PTSD and that individuals with PTSD tend to claim cognitive impairment. Implications of these findings are discussed with regard to the existing literature and the relationship between these two types of symptom validity tests.

Potential neuropsychological profiles in welders occupationally exposed to manganese: an examination of effect size patterns.

This study used effect sizes to examine two recently published articles by Bowler et al. (2003, 2006) that purport to show that welders who had been occupationally exposed to manganese demonstrate a specific pattern of neuropsychological impairment. In the two articles, the welding groups were composed of different participants, but the control group was composed of the same participants in both studies. A similar neuropsychological battery was administered across studies. Effect size differences between welders and controls were quite different across both studies, and the pattern of effect sizes within each study for neuropsychological domains was different. Taken together, these articles do not support the claim that chronic manganese exposure in welders results in a specific and identified pattern of neuropsychological impairment.