Invited Commentary: Advancing but not yet Advanced: Assessment of Effort/Malingering in Forensic and Clinical Settings.

Neuropsychologists' conclusions and courtroom testimony on malingering can have profound impact. Intensive and ingenious research has advanced our capacities to identify both insufficient and sufficient effort and thus make worthy contributions to just conflict resolution. Nevertheless, given multiple converging factors, such as misleadingly high accuracy rates in many studies, practitioners may well develop inflated confidence in methods for evaluating effort/malingering. Considerable research shows that overconfidence often increases diagnostic and predictive error and may lead to fixed conclusions when caution is better advised. Leonhard's work thus performs an important service by alerting us to methodological considerations and shortcomings that can generate misimpressions about the efficacy of effort/malingering assessment. The present commentary covers various additional complicating factors in malingering assessment, including other factors that also inflate confidence; subtle and perhaps underappreciated methodological flaws that are inversely related to positive study outcomes (i.e., the worse the flaws the better methods appear to be); oversimplified classifications schemes for studying and evaluating effort that overlook, for example, common mixed presentations (e.g., malingering and genuinely injured); and the need to expand research across a greater range and severity of neuropsychological conditions and diverse groups. More generally, although endorsing various points that Leonhard raises, a number of questions and concerns are presented, such as methods for calculating the impact of case exclusions in studies. Ultimately, although Leonhard's conclusions may be more negative than is justified, it seems fair to categorize methods for assessing malingering/effort as advancing, but not yet advanced, with much more needed to be done to approach that latter status.

A Neuropsychological Perspective on Defining Cognitive Impairment in the Clinical Study of Alzheimer's Disease: Towards a More Continuous Approach.

The global fight against Alzheimer's disease (AD) poses unique challenges for the field of neuropsychology. Along with the increased focus on early detection of AD pathophysiology, characterizing the earliest clinical stage of the disease has become a priority. We believe this is an important time for neuropsychology to consider how our approach to the characterization of cognitive impairment can be improved to detect subtle cognitive changes during early-stage AD. The present article aims to provide a critical examination of how we define and measure cognitive status in the context of aging and AD. First, we discuss pitfalls of current methods for defining cognitive impairment within the context of research shifting to earlier (pre)symptomatic disease stages. Next, we introduce a shift towards a more continuous approach for identifying early markers of cognitive decline and characterizing progression and discuss how this may be facilitated by novel assessment approaches. Finally, we summarize potential implications and challenges of characterizing cognitive status using a continuous approach.

Immediate Post-concussion and Cognitive Testing: Ceiling Effects, Reliability, and Implications for Interpretation.

OBJECTIVE: The most commonly used computerized neurocognitive test in concussion assessment and management, Immediate Post-concussion and Cognitive Testing (ImPACT), has demonstrated varying and sometimes concerning levels of test-retest reliability. This study aimed to further examine ImPACT's psychometric qualities and whether ceiling effects may suppress its reliability. METHOD: A total of 300 consecutively selected ImPACT score reports for students attending a secondary school between 2010 and 2015 were reviewed. Test-retest reliabilities for composite scores and subscales were computed using Pearson product moment correlations (r) and intraclass correlation coefficients. To examine the potential influence of ceiling effects, we conducted frequency analyses of scores falling at, or near, the maximum possible score. RESULTS: A total of 92 score reports met inclusion criteria. Test-retest reliabilities ranged from 0.42 to 0.69 for composite scores and 0.19 to 0.71 for subscales. Subscales comprising the Verbal and Visual Memory composites evidenced the most prominent ceiling effects. CONCLUSIONS: Obtained test-retest reliabilities were consistent with a large segment of the literature and add to concerns about ImPACT's reliability. Furthermore, at least in a select sample, this study identified sizeable ceiling effects that likely diminish the reliability of some composite scores. To mitigate the risk of false-negative errors on post-injury testing, ImPACT users should be cognizant of such ceiling effects. Supplemental, or alternative, approaches to protect against underestimating baseline functioning also warrant consideration.

Refining Measures for Assessing Problematic/Addictive Digital Gaming Use in Clinical and Research Settings.

Problematic or addictive digital gaming (including all types of electronic devices) can and has had extremely adverse impacts on the lives of many individuals across the world. The understanding of this phenomenon, and the effectiveness of treatment design and monitoring, can be improved considerably by continuing refinement of assessment tools. The present article briefly overviews tools designed to measure problematic or addictive use of digital gaming, the vast majority of which are founded on the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for other addictive disorders, such as pathological gambling. Although adapting DSM content and strategies for measuring problematic digital gaming has proven valuable, there are some potential issues with this approach. We discuss the strengths and limitations of current methods for measuring problematic or addictive gaming and provide various recommendations that might help in enhancing or supplementing existing tools, or in developing new and even more effective tools.

The admissibility of behavioral science evidence in the courtroom: the translation of legal to scientific concepts and back.

Starting with the Daubert case, courtroom rules and guides regulating the admissibility of scientific evidence have undergone major revisions over the past 10 to 15 years. We review these changes and current legal rules and guides, in particular their impact on the admission of behavioral sciences evidence and testimony. We examine commonly intended meanings, conceptualizations, and language use relating to science and the admission of evidence within the legal system and their relation to more familiar terms and concepts within the behavioral sciences, identifying points of continuity and discontinuity. We then review illustrative legal cases involving challenges to the admission of psychological and psychiatric evidence and their implications for mental health professionals. Finally, we offer a framework for conceptualizing and prioritizing key legal criteria for determining admissibility and appraising standing on these factors within the mental health field. Increased mutual understanding between psychology and law should further enhance productive interfaces between the disciplines and add to the many instances in which the proper use of science in the courtroom has facilitated fair resolution of legal conflicts.

Paul Meehl as methodologist-philosopher of science: the formulation of metascience.

Paul Meehl's contributions to methodology and the philosophy of science extend well beyond his widely known writings in such areas as construct validity and statistical significance testing. I describe one of Meehl's less well-known, but potentially most important, methodological undertakings: his work on metascience, or the science of science. Metascience could ultimately revolutionize our conceptualizations and understanding of science and provide considerable help to practicing scientists and scientific endeavors, including efforts to advance the development and appraisal of theories in psychology.

Why Paul Meehl will revolutionize the philosophy of science and why it should matter to psychologists.

Paul Meehl was a person of remarkable genius who made many seminal contributions to psychology and other fields. One of his most important, but less widely known potential contributions is the codevelopment, and the extension and elaboration of meta-science, or the science of science. Meta-science involves applying more rigorous methods (than are usually used) to the study of episodes in the history of science, or the historical track record, in order to address long-standing questions in the philosophy and history of science, aid in the selection of optimally effective methodology, and assist the scientist in higher level and complex integrative judgments (e.g., theory evaluation). Psychologists, given their methodological sophistication, can be major contributors to meta-scientific efforts and to the development of this field.

Holistic thinking is not the whole story: alternative or adjunct approaches for increasing the accuracy of legal evaluations.

There are a number of very helpful, but often underutilized, principles and procedures that can augment decision making in clinical and legal settings. Psychologists often restrict their range of decision-making strategies and options--at the cost of maximizing diagnostic and predictive accuracy--in part as the result of "ontological-epistemological one-worldedness" (O-E O-W). However, no philosophical, logical, or scientific necessity demands strict consistency between views regarding the nature of psychological phenomena and views about how to best assess or learn about those phenomena. Relaxing this unnecessary and largely psychologically-based O-E O-W may promote greater comfort with and utilization of the methods that are discussed in this article for increasing judgmental accuracy.

Iatrogenic symptoms in psychotherapy. A theoretical exploration of the potential impact of labels, language, and belief systems.

Although the mental health professions are effective in ameliorating personal distress, treatment can sometimes have negative consequences. The authors explore causal mechanisms for iatrogenic symptoms in therapy by discussing the processes by which clients may be socialized into therapy and the potential impact that psychiatric labels and language may have in influencing clients' self-perceptions. The authors review research that has examined possible negative effects of psychiatric labels and then examine other forms of language, categorization, and conceptualizations that may contribute to negative effects in therapy. Iatrogenic symptoms may originate through the over-reliance on a belief system within which therapists interpret, reinterpret, or label clients' characteristics or distress as pathological. Therapeutic communication that emphasizes pejorative language may introduce clients to this belief system. Iatrogenic symptoms may also provide clients and therapists with secondary gains. Possible approaches for minimizing iatrogenic symptoms are explored.