Comparability of Structured Interview of Reported Symptoms (SIRS) and Structured Interview of Reported Symptoms-Second Edition (SIRS-2) classifications with external response bias criteria.

Rogers, Sewell, and Gillard (2010) released a revised version of the Structured Interview of Reported Symptoms (SIRS; Rogers, Bagby, & Dickens, 1992), the SIRS-2, which introduced several new scales, indices, and a new classification model with the overall goal of improving its classification of genuine versus feigned presentations. Since the release of the SIRS-2, several concerns have been raised regarding the quality of the SIRS-2 development and validation samples and the method used to calculate classification accuracy estimates. To further explore issues related to the clinical utility of the SIRS-2, the current study examined associations of the SIRS and SIRS-2 with the Minnesota Multiphasic Personality Inventory-2-Restructured Form (Ben-Porath & Tellegen, 2008/2011) validity scales in separate samples of disability claimants and criminal defendants. Results indicate that the SIRS-2 reduced the number of feigning classifications. Additional analyses suggest that the Modified Total Index and Supplementary Scale Index do not assess the test-taking strategy that Rogers and colleagues (2010) intended the indices to capture. External data indicates that evaluees reclassified on the SIRS-2 in nonfeigning categories exhibited feigned symptoms of psychopathology. Indeed, we found that SIRS-identified feigners showed significant evidence of overreporting on the Minnesota Multiphasic Personality Inventory-2-Restructured Form validity scales, regardless of their SIRS-2 classification. The current study highlights the overall weakness in clinical utility of the SIRS-2. Implications of these results for both clinical and forensic settings are discussed. (PsycINFO Database Record

Mild Traumatic Brain Injury Update: Forensic Neuropsychiatric Implications.

Traumatic brain injury (TBI) involves a wide range of potential neuropsychiatric outcomes, from death or profound impairment to full and fast recovery. This circumstance has contributed to an atmosphere with considerable potential for both clinical confusion and unjustified medicolegal outcomes. Given that mild (m)TBI accounts for most (∼80%) TBI events and is generally associated with an excellent prognosis, the risk for erroneous clinical formulations and unmerited legal outcomes seems particularly high in cases involving mTBI. In this article, we summarize the recent results published by the International Collaboration on Mild Traumatic Brain Injury Prognosis (ICMTBIP) and the new approach of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, to TBI, and we explore the clinical and medicolegal implications. Symptoms that emerge after mTBI remain nonspecific, and potential etiologies are diverse. Clinicians and medicolegal experts should be familiar with the natural history of mTBI, able to recognize atypical outcomes, and willing to search for alternative explanations when confronted with persistent or severe impairment.

Assessment of validity and response bias in neuropsychiatric evaluations.

BACKGROUND: Forensic neuropsychiatric assessment requires thorough consideration of malingering and response bias. Neuropsychiatric evaluations are complicated due to the multiple domains in which symptoms and impairment present. Moreover, symptom exaggeration in these evaluations can also present along various symptom domains (e.g., psychological, neurocognitive, somatic). Consequently, steps must be taken to ensure adequate coverage of response bias across all three domains of function. PURPOSE: The following article reviews the conceptualization of malingering in neuropsychiatric settings, as well as various approaches and measures that can be helpful in the assessment of malingering and response bias. CONCLUSIONS: Forensic neuropsychiatric assessment requires thorough consideration of malingering and response bias. These evaluations are complicated due to the multiple domains in which symptoms and impairment present. Performance and symptom validity measures should be routinely included in these evaluations. Collaboration between psychiatry and psychology can provide the optimal multi-method approach needed for thorough neuropsychiatric assessment in forensic cases. We illustrate our points with two case studies from forensic traumatic brain injury neuropsychiatric evaluations.

Embedded effort scales in the repeatable battery for the assessment of neuropsychological status: do they detect neurocognitive malingering?

The current study examined two embedded response bias measures in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Effort Index (EI) and Effort Scale (ES), in relation to Malingered Neurocognitive Dysfunction criteria. We examined 105 individuals undergoing compensation-seeking disability evaluations. The results suggest the EI adequately differentiates the Probable/Definite Malingering group from the Incentive Only and Possible Malingering groups, while the ES does not, which is most likely representative of the current sample of disability litigants rather than its intended population of patients with amnesia. Classification accuracy statistics suggest that while the EI may not be an appropriate stand-alone measure in detecting neurocognitive malingering, it shows utility as a complementary or screening measure in forensic settings.

Can brief measures effectively screen for pain and somatic malingering? Examination of the Modified Somatic Perception Questionnaire and Pain Disability Index.

BACKGROUND CONTEXT: Recent rise in fraudulent disability claims in the United States has resulted in psychologists being increasingly called upon to use psychological tests to determine whether disability claims based on psychological or somatic/pain complaints are legitimate. PURPOSE: To examine two brief measures, Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI), and their ability to screen for malingering in relation to the Bianchini et al. criteria for malingered pain-related disability published in The Spine Journal (2005). STUDY DESIGN: Examined brief self-report measures between litigating and nonlitigating pain samples. PATIENT SAMPLE: We compared 144 disability litigants, predominantly presenting a history of musculoskeletal injuries with psychiatric overlay, with 167 nonlitigating pain patients who were predominantly in treatment for chronic back pain issues and other musculoskeletal conditions. OUTCOME MEASURES: Modified Somatic Perception Questionnaire, Pain Disability Index, Minnesota Multiphasic Personality Inventory-2 Restructured Form, Test of Memory Malingering, Letter Memory Test, Victoria Symptom Validity Test, Structured Interview of Reported Symptoms-second edition, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders somatoform disorders module. METHODS: We examined a sample of 144 individuals undergoing compensation-seeking evaluations in relation to 167 nonlitigating pain patients. RESULTS: Group differences on both the MSPQ and PDI were calculated, as well as sensitivities, specificities, and positive and negative predictive powers for both measures at selected cutoffs. CONCLUSIONS: The results suggest that both the MSPQ and PDI are useful to screen for pain malingering in forensic evaluations, especially the MSPQ, which performed the best in differentiating between the groups.

It's not all in your head (or at least your brain): association of traumatic brain lesion presence and location with performance on measures of response bias in forensic evaluation.

This study examined the relationship between lesion presence and localization and performance on measures of cognitive response bias, specifically in individuals purporting to have a traumatic brain injury. Ninety-two participants, all of whom were involved in workers' compensation or personal injury litigation, were administered an extensive neuropsychological battery, including neuroimaging (magnetic resonance imaging and computed tomography), at a neuropsychiatric clinic in Lexington, KY. Those with evidence of intracranial injury on neuroimaging findings were placed in the head injury lesion litigation group and were coded based on the anatomical location and type of intracranial injury. Results demonstrated no significant relationships between lesion location and performance on performance validity tests (PVTs), as well as the Response Bias Scale of the Minnesota Multiphasic Personality Inventory-2 Restructured Form. Given the lack of research concerning lesions and performance validity tests, this study addresses important questions about the validity of PVTs as specific measures of response bias in patients who have structural changes secondary to traumatic brain injury.

Feigned neurocognitive deficit: taxon or dimension?

The purpose of this study was to explore the latent structure of feigned neurocognitive deficit. Scores on the Test of Memory Malingering (TOMM), Letter Memory Test (LMT), and Victoria Symptom Validity Test (VSVT) served as indicators in a taxometric investigation of 527 compensation-seeking adults using three taxometric procedures -- mean above minus below a cut (MAMBAC), maximum covariance (MAXCOV), and latent-mode factor analysis (L-Mode). All three procedures showed evidence of dimensional latent structure. The fact that feigned neurocognitive symptomatology is ordered along a continuum rather than bifurcating into distinct categories has important implications for theory, research, and clinical practice.

Use of the SIRS in compensation cases: an examination of its validity and generalizability.

The Structured Interview of Reported Symptoms (SIRS; Rogers et al., Structured interview of reported symptoms (SIRS) and professional manual, 1992) is a well-validated psychological measure for the assessment of feigned mental disorders (FMD) in clinical, forensic, and correctional settings. Comparatively little work has evaluated its usefulness in compensation and disability contexts. The present study examined SIRS data from 569 individuals undergoing forensic neuropsychiatric examinations for the purposes of workers' compensation, personal injury, or disability proceedings. Using bootstrapping comparisons, three primary groups were identified: FMD, feigned cognitive impairment (FCI), genuine-both (GEN-Both) that encompasses both genuine disorders (GEN-D) and genuine-cognitive presentation (GEN-C). Consistent with the SIRS main objective, very large effect sizes (M Cohen's d = 1.94) were observed between FMD and GEN-Both groups. Although not intended for this purpose, moderate to large effect sizes (M d = 1.13) were found between FCI and GEN-Both groups. An important consideration is whether SIRS results are unduly affected by common diagnoses or clinical conditions. Systematic comparisons were performed based on common disorders (major depressive disorder, PTSD, and other anxiety disorders), presence of a cognitive disorder (dementia, amnestic disorder, or cognitive disorder NOS), or intellectual deficits (FSIQ < 80). Generally, the magnitude of differences on the SIRS primary scales was small and nonsignificant, providing evidence of the SIRS generalizability across these diagnostic categories. Finally, the usefulness of the SIRS improbable failure-revised (IF-R) scale was tested as a FCI screen. Although it has potential in ruling out genuine cases, the IF-R should not be used as a feigning screen.

Screening for feigning in a civil forensic setting.

This study compared the effectiveness of the Structured Inventory of Malingered Symptoms (SIMS; Widows & Smith, 2005) and the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001) at screening for feigned psychiatric and neurocognitive symptoms in 308 individuals undergoing neuropsychiatric evaluation for workers' compensation or personal injury claims. Evaluees were assigned to probable feigning or honest groups based on results from well-validated, independent procedures. Both tests showed statistically significant discrimination between probable feigning and honest groups. Additionally, both the M-FAST and SIMS had high sensitivity and negative predictive power when discriminating probable psychiatric feigning versus honest groups, suggesting effectiveness in screening for this condition. However, neither of the procedures was as effective when applied to probable neurocognitive feigners versus honest groups, suggesting caution in their use for this purpose.

Malingering as a categorical or dimensional construct: the latent structure of feigned psychopathology as measured by the SIRS and MMPI-2.

The 6 nonoverlapping primary scales of the Structured Interview of Reported Symptoms (SIRS) were subjected to taxometric analysis in a group of 1,211 criminal and civil examinees in order to investigate the latent structure of feigned psychopathology. Both taxometric procedures used in this study, mean above minus below a cut (MAMBAC) and maximum covariance (MAXCOV), produced dimensional results. A subgroup of participants (n = 711) with valid Minnesota Multiphasic Personality Inventory-2 (MMPI-2) protocols were included in a second round of analyses in which the 6 nonoverlapping primary scales of the SIRS and the Infrequency (F), Infrequency-Psychopathology (Fp), and Dissimulation (Ds) scales of the MMPI-2 served as indicators. Again, the results were more consistent with dimensional latent structure than with taxonic latent structure. On the basis of these findings, it is concluded that feigned psychopathology forms a dimension (levels of fabrication or exaggeration) rather than a taxon (malingering-honest dichotomy) and that malingering is a quantitative distinction rather than a qualitative one. The theoretical and clinical practice implications of these findings are discussed.

Use of MMPI-2 to predict cognitive effort: a hierarchically optimal classification tree analysis.

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context.

Commentary: Applications of functional neuroimaging to civil litigation of mild traumatic brain injury.

The current definition of mild traumatic brain injury (MTBI) is in flux. Presently, there are at least three working definitions of this disorder in the United States, with no clear consensus. Functional neuroimaging, such as single photon emission computed tomography (SPECT) and positron emission tomography (PET), initially showed promise in their ability to improve the diagnostic credibility of MTBI. Over the past decade, that promise has not been fulfilled and there is a paucity of quality studies or standards for the application of functional neuroimaging to traumatic brain injury, particularly in litigation. The legal profession is ahead of the science in this matter. The emergence of neurolaw is driving a growing use of functional neuroimaging, as a sole imaging modality, used by lawyers in an attempt to prove MTBI at trial. The medical literature on functional neuroimaging and its applications to MTBI is weak scientifically, sparse in quality publications, lacking in well-designed controlled studies, and currently does not meet the complete standards of Daubert v. Merrell Dow Pharmaceuticals, Inc., for introduction of scientific evidence at trial. At the present time, there is a clear lack of clinical correlation between functional neuroimaging of MTBI and behavioral, neuropsychological, or structural neuroimaging deficits. The use of SPECT or PET, without concurrent clinical correlation with structural neuroimaging (CT or MRI), is not recommended to be offered as evidence of MTBI in litigation.

Response validity in forensic neuropsychology: exploratory factor analytic evidence of distinct cognitive and psychological constructs.

Forensic neuropsychology studies usually address either cognitive effort or psychological response validity. Whether these are distinct constructs is unclear. In 122 participants evaluated in a compensation-seeking context, the present Exploratory Factor Analysis examined whether forced-choice cognitive effort measures (Victoria Symptom Validity Test, Test of Memory Malingering, Letter Memory Test) and Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) validity scales (L, F, K, FBS, Fp, RBS, Md, Dsr2, S) load on independent factors. Regardless of factor rotation strategy (orthogonal or oblique), four response validity factors emerged by means of both Principal Components Analysis (82.7% total variance) and Principal-Axis Factor Analysis (74.1% total variance). The four factors were designated as follows: Factor I, with large loadings from L, K, and S--underreporting of psychological symptoms; Factor II, with large loadings from FBS, RBS, and Md-overreporting of neurotic symptoms; Factor III, with large loadings from VSVT, TOMM, and LMT--insufficient cognitive effort; and Factor IV, with the largest loadings from F, Fp, and Dsr2--overreporting of psychotic/rarely endorsed symptoms. Results reflect the heterogeneity of response validity in forensic samples referred for neuropsychological evaluation. Administration of both cognitive effort measures and psychological validity scales is imperative to accurate forensic neuropsychological assessment.

Known-groups cross-validation of the letter memory test in a compensation-seeking mixed neurologic sample.

Compensation-seeking neuropsychological evaluees were classified into Honest (HON; n = 37) or Probable Cognitive Feigning (PCF; n = 53) groups based on results from the Victoria Symptom Validity Test, the Test of Memory Malingering, and the Digit Span subtest of the Wechsler Adult Intelligence Scale--3rd ed. The groups were generally comparable on demographic, background, and injury severity characteristics, although HON TBI participants were significantly more likely to have a documented loss of consciousness, whereas PCF participants were significantly more likely to be currently on disability. PCF participants scored significantly lower on many neuropsychological test, particularly of memory, as well as higher on most MMPI-2 clinical scales. The PCF group also had significantly higher scores on multiple indices of feigning of psychiatric symptoms. Results from the Letter Memory Test (LMT) were significantly lower for the PCF group, and using the recommended cutting score, specificity was .984, whereas sensitivity was .640, suggesting adequate performance on cross-validation.