Further investigation of traumatic brain injury versus insufficient effort with the California Verbal Learning Test.

The present study replicates and attempts to extend previous research using the California Verbal Learning Test (CVLT) to identify malingerers. Documented moderate and severe traumatic brain injury patients (n = 42) were compared with clinical malingerers identified by criteria other than the CVLT (n = 21), malingering simulators instructed in realistic potential injury sequelae (n = 25), and normal controls (n = 21). Results of discriminant function analyses for high and low base rates are reported, showing similar results. Also, the four individual cutoff scores (Recognition Hits, Discriminability, Total Words Recalled, Long Delay Cued Recall) from Millis, Putnam, Adams, and Ricker (1995) were evaluated with these groups. Similar specificity rates were found with all four variables, while sensitivity rates were slightly lower than that of Millis. Adjusted cutoffs derived from the new samples resulted in slightly improved overall classification rates. Overall, present findings support those of Millis et al. (1995) with regard to the use of the CVLT in detection of malingering. Exploratory use of Total Intrusions and Recognition Hits Compared to Long Delay Free Recall was not promising. Simulators were found to be fairly comparable in performance to actual malingerers, affirming their use in malingering research.

Neuropsychological assessment and malingering: a critical review of past and present strategies.

In recent years, neuropsychologists and clinical psychologists have shown a greatly increased interest in methods of discriminating malingerers from legitimate psychiatric and neurological patients. In part, this increased interest has resulted from increased demand from the legal system (i.e., pertaining to disposition of personal injury, worker's compensation, medical malpractice, and criminal cases) for expert psychological testimony which can distinguish malingering from genuine neuropsychological deficits. Additional interest, and some controversy, has been generated by recent research studies that have reported no success in diagnosing malingering, although others have reported more positive evidence. The present literature review describes the historical and current methods of detecting malingerers, along with the empirical evidence supporting, or condemning, their use. The majority of empirical studies suggest that although malingering of brain dysfunction is not easy to detect, it is possible to detect, if looked for deliberately. Review and critique of the available strategies indicates that a multidimensional, multimethod approach is needed. Continued research effort is needed on this important clinical issue.

Relative absence of neuropsychological deficit in patients with low grade astrocytomas.

Given the current accuracy and precision of modern brain imaging technology, there is presumed to be little utility in neuropsychological assessment procedures in patients with brain tumors. The primary exposure of many clinical neuropsychologists to patients with brain tumors is during their training, in the form of didactic classroom activities, such as reviewing the brain tumor cases of early investigators in the field. Historically, these brain tumors were the more aggressive and destructive tumors, such as grade III and IV astrocytomas, that could be identified with pre CT and pre MRI technology. With current imaging technology, low grade tumors that might previously have gone undiagnosed for years can be detected and patients followed over time. This series of cases represents documentation of the very unique neuropsychological status of patients with relatively slow growing, infiltrative brain tumors classified as grade II astrocytomas. The potential relevance of neuropsychological assessment for such cases is discussed.