Effectiveness of NEO-PI-R research validity scales for discriminating analog malingering and genuine psychopathology.

We investigated the research validity scales for the NEO Personality Inventory-Revised (NEO-PI-R) proposed by Schinka, Kinder, and Kremer (1997): Positive Presentation Management (PPM) and Negative Presentation Management (NPM). Additionally, an experimental analog to the Minnesota Multiphasic Personality Inventory-2's (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) F-K index was calculated by subtracting the raw score on PPM from the raw score on NPM (NPM-PPM). In 2 studies, all indexes showed significant between-group differences when samples of analog malingerers (n = 97) were contrasted with psychiatric outpatients (n = 272). The sensitivity and specificity of these validity indexes indicated that although none performed well in extremely low base rate environments, the NPM and NPM-PPM indexes showed promise when the base rate of faking bad rose to higher levels.

MMPI-2 fake-bad scales: an attempted cross-validation of proposed cutting scores for outpatients.

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) results were compared in 118 psychiatric outpatients given standard instructions, instructions to exaggerate their problems, instructions to feign a disorder they did not have, or instructions to feign global psychological disturbance. The groups were comparable on demographic, occupational and diagnostic characteristics as well as intake MMPI-2 results. Experimental MMPI-2 results showed that clinical scales were generally elevated in the feigning groups, with only modest differences across dissimulating instruction sets. The feigning groups had reliably higher scores than controls on all overreporting indexes examined, although no significant differences between feigning groups were present for overreporting indexes. Classification rates using previously proposed cutting scores for outpatients on individual feigning indexes showed near perfect specificity, but low to at best moderate sensitivity. Multiple regression analyses indicated that Gough's (1954) Dissimulation Scale (Ds2) was most strongly related to feigning status, and no other feigning scale contributed a significant increment in predictive power once Ds2 was entered.

Detection of inadequate effort on neuropsychological testing: a meta-analytic review of selected procedures.

Thirty-two studies of commonly researched neuropsychological malingering tests were meta-analytically reviewed to evaluate their effectiveness in discriminating between honest responders and dissimulators. Overall, studies using the Digit Memory Test (DMT), Portland Digit Recognition Test (PDRT), 15-Item Test, 21-Item Test, and the Dot Counting Test had average effect sizes indicating that dissimulators obtain scores that are approximately 1.1 standard deviations below those of honest responders. The DMT separated the means of groups of honest and dissimulating responders by approximately 2 standard deviations, whereas the 21-Item Test and the PDRT separated the groups by nearly 1.5 and 1.25 standard deviations, respectively. The 15-Item Test and the Dot Counting Test were less effective, separating group means by approximately 3/4 of a standard deviation. Although the DMT, PDRT, 15-, and 21-Item Tests all demonstrated very high specificity rates, at the level of individual classification, the DMT had the highest sensitivity and overall hit-rate parameters. The PDRT and 15-Item Test demonstrated moderate sensitivity, whereas the 21-Item Test demonstrated poor sensitivity. The less than perfect sensitivities of all the measures included in this review argue against their use in isolation as malingering screening devices.

Meta-analytic methods, the Rorschach, and the MMPI.

In response to concerns described by H. N. Garb, J. M. Wood, M. T. Nezworski, W. M. Grove, and W. J. Stejskal (2001), the authors present the weighted and unweighted means and medians of the effect sizes obtained by J. B. Hiller, R. Rosenthal, R. F. Bornstein, D. T. R. Berry, and S. Brunell-Neuleib (1999). These indices of central tendency are presented separately for Minnesota Multiphasic Personality Inventory (MMPI) and Rorschach effect sizes, both for all the studies in the meta-analysis and for a 10% trimmed sample designed to obtain more robust estimates of central tendency. The variability of these 4 indices is noticeably greater for the MMPI than for the Rorschach. Meta-analysts must compute, compare, and evaluate a variety of indices of central tendency, and they must examine the effects of moderator variables. The authors also comment briefly on the use of phi versus kappa, combining correlated effect sizes and possible hindsight biases.

Effects of response sets on NEO-PI-R scores and their relations to external criteria.

Validity scales indicate the extent to which the results of a self-report inventory are a valid indicator of the test taker's psychological functioning. Validity scales generally are designed to detect the common response sets of positive impression management (underreporting, or faking good), negative impression management (overreporting, or faking bad), and random responding. The revised NEO Personality Inventory (NEO-PI-R; Costa & McCrae, 1992b) is a popular personality assessment tool based on the 5-factor model of personality and is used in a variety of settings. The NEO-PI-R does not include objective validity scales to screen for positive or negative impression management. The purpose of this study was to examine the utility of recently proposed validity scales for detecting these response sets on the NEO-PI-R (Schinka, Kinder, & Kremer, 1997) and to examine the effects of positive and negative impression management on correlations between the NEO-PI-R and external criteria (the Interpersonal Adjective Scale-Revised-B5 [Wiggins & Trapnell, 1997] and the NEO-PI-R Form R). The validity scales discriminated with reasonable accuracy between standard responding and the 2 response sets. Additionally, most correlations between the NEO-PI-R and external criteria were significantly lower when participants were dissimulating than when responding to standard instructions. It appears that response sets of positive and negative impression management may pose a significant threat to the external validity of the NEO-PI-R and that validity scales for their detection might be a useful addition to the inventory.

The effects of two motivational manipulations on the neuropsychological performance of mildly head-injured college students.

Recently, much research has focused on the development and utilization of various motivational assessment techniques designed to identify malingered neuropsychological test performance. Other findings have suggested a strong link between the motivation of the subject and the degree to which the neuropsychological test results validly represent the individual's true level of functioning. However, the majority of the empirical work in this area has focused on only one end of the motivational spectrum, decreased motivation. In order to obtain a more complete assessment of the relationship between motivation and neuropsychological of test results, the present study involved an evaluation of the effects of motivational differences on test performance across three levels of motivation: high, low, and standard in 75 head-injured college students. Results supported past research showing significant decreases in test performance by participants given individual financial incentives (25.00 US dollars) to perform poorly. Additionally, the sensitivity of several malingering tests to this response set was supported. However, no reliable differences were found on neuropsychological or motivational tests between the group given financial incentives (25.00 US dollars) to perform well and the standard instruction group.

Pulmonary function testing: detection of invalid performance.

We surveyed physician members of the American Thoracic Society and their technicians regarding indicators of the validity of PFTs. Surveys were returned by 50 physicians and 52 technicians. Both groups felt that consistency of effort and the shape/slope of the curve were important indicators, with behavioral observations rated slightly lower. Approximately 38% of physicians and 19% of technicians felt that they detected 75% or fewer of individuals giving inadequate effort during PFTs. Twenty percent of physicians and 29% of technicians were using quantitative criteria other than those recommended by the 1979 "Snowbird" technical paper to determine acceptability of PFTs. Twenty-eight percent of physicians and 31% of technicians spontaneously indicated that patients pursuing compensation or disability claims for pulmonary disorders were most likely to give suboptimal effort. Empirical research into the impact and detection of suboptimal effort on PFTs is encouraged.

Detection of random responding on the MMPI-A.

We examined random responding on the MMPI-A in 106 adolescents from the general population. Participants were asked to report on the frequency, location, and reasons for any random responses occurring during a standard administration of the MMPI-A. Relationships between self-reported random responding and validity indices (F1, F2, F, and Variable Response Inconsistency [VRIN] scale) were examined. In addition, each participant was randomly assigned to 1 of 5 groups, with each group completing an assigned portion (0, 25%, 50%, 75%, or 100%) of an MMPI-A answer sheet without access to the test booklet, and the utility of the validity scales in discriminating standard protocols from all or partially random protocols was investigated. Most adolescents acknowledged one or more random responses correlated significantly with F but not VRIN. Validity scales were sensitive to all or partially random protocols, and produced high classification rates when discriminating among groups.

Sleep-disordered breathing in healthy, aged persons. Fifth and final year follow-up.

The frequency of sleep-disordered breathing (SDB) events increases dramatically with age, although the clinical significance of this phenomenon is uncertain. We report herein on data from the fifth follow-up observation of a cohort of healthy elderly which we selected, evaluated, and followed up in an effort to address this issue. Baseline observations on this group of 95 normal older persons medically screened for good health included standard nocturnal polysomnograms and daytime assessment of medical, sleep/wake, and psychological variables. At fifth-year follow-up, 42 subjects returned for assessment. Comparison of returning vs nonreturning subjects indicated no significant differences in baseline characteristics between these groups. Division of returning subjects into moderate (apnea-hypopnea index [AHI] > or = 5) vs low (AHI < 5) SDB at baseline resulted in 10 subjects in the moderate group and 32 subjects in the low group. The two groups were comparable with regard to sex, weight, and education, although the moderate SDB group was significantly older (70.4 years) than the low SDB group (64.8 years). Follow-up medical, sleep/wake, and psychological data were contrasted for the two groups using a mixed design multivariate analysis of variance (repeated measures factor-time-6 observations; between-subjects factor SDB level, 2 groups). There were no statistically significant effects of SDB or interactions of SDB and time across this 5-year follow-up. These results confirm observations from the third-year follow-up. We conclude that observation of a moderate level of SDB in an otherwise healthy older person is apparently not a significant risk across a 5-year follow-up period and therefore does not seem to warrant investigation beyond a thorough medical history and physical examination to rule out other disorders.

Detection of a Cry for Help on the MMPI-2: an analog investigation.

We compared Minnesota Multiphasic Personality Inventory (MMPI-2) results from 2 groups of mildly to moderately disturbed psychiatric outpatients (N=60) answering under either Standard or Cry for Help instructions. Results from previously completed intake MMPI-2 protocols were obtained for each participant. The two groups were comparable on intake MMPI-2 variables and demographic characteristics. Analysis of feedback data from the second, experimental observation indicated that the two groups had equivalent self-estimates of understanding of their role and success in simulating their role. Significant differences were found between the two groups on their experimental MMPI-2 protocols. The Cry for Help group had significantly higher scores on F, F-K, Fb, Ds2, and Fp scales as well as significantly lower scorns on the K scale. The Cry for Help group also had significantly higher scores on all clinical scales with the exception of 5, which was not tested. Cutting scores derived by Rogers, Sewell, and Ustad (1995) for the detection of a Cry for Help in outpatients were cross-validated with fairly positive results. Although these results are promising, particularly in light of the shrinkage expected on cross-validation, further research is needed in this area.

Self report on sleep symptoms in older adults: correlates of daytime sleepiness and health.

Sleep problems in the healthy elderly were studied in 628 community-dwelling older adults. Self-report of daytime sleepiness in this group was evaluated. Self-reported snoring was significantly associated with reports of daytime sleepiness (p < 0.001), and reported health showed significant associations with age group (p < 0.001), reports of breathing problems (p < 0.001), and reports of excessive daytime sleepiness (p < 0.01). The data strongly support the impact of sleep-related factors on self-perceptions of health in community dwelling older adults. Even as a subjective self-report measure, snoring readily predicts self-reported problems with daytime sleepiness.

Nocturnal bruxing events: a report of normative data and cardiovascular response.

Twenty subjects referred to a sleep laboratory for evaluation of sleep apnoea and found not to have any sleep disordered breathing problems were evaluated in this study. Bruxing events were recorded for frequency, duration, association with sleep stage and sleep position. The possible association between leg movements and bruxing events was also evaluated, but did not reveal any common mechanism. This study revealed that heart rate during bruxing events increased on average by 16.6%.

Sleep-disordered breathing in healthy aged persons: two- and three-year follow-up.

We report the results of a study of the effects of sleep-disordered breathing in a cohort of healthy elderly subjects followed longitudinally for 3 years. In a comprehensive evaluation of daytime functioning, including medical history and physical examination, pulmonary function testing and neuropsychiatric testing, we found very little difference in the neuropsychiatric or medical sequelae between those subjects with moderate [apnea+hypopnea index (AHI) > or = 5] and low (AHI < 5) levels of sleep-disordered breathing at baseline. Although there were no differences in the electrocardiogram, pulse rate or cardiac history data, a mild association was found between indices of sleep-disordered breathing and pulmonary function. We conclude that moderate levels of sleep-disordered breathing in an otherwise asymptomatic healthy geriatric patient should probably not be considered pathologic in the short term.

The New Adult Reading Test-Revised: accuracy in estimating WAIS-R IQ scores obtained 3.5 years earlier from normal older persons.

Scores on the New Adult Reading Test-Revised (NART-R) were used to estimate WA1S-R IQ scores obtained approximately 3.5 years earlier from 54 normal older persons (M = 68 y; SD = 8.6). NART-R estimated IQ scores correlated reliably with earlier obtained IQ scores: FS1Q r = 0.70; VIQ r = 0.68; PIQ r = 0.61 (all p's < 0.05). NART-R estimated FSIQs underpredicted obtained FSIQs by an average of 3.8 points (SD = 9.3). The correlation between estimated and obtained FSIQ is fairly high and estimated FSIQ is reasonably close to obtained IQ, despite the considerable length of time passing between WAIS-R and NART-R administration. These results represent the first confirmation of the retrospective accuracy of the NART-R in estimating WAIS-R scores across time, a previously untested but critical assumption for clinical application of this approach. These results also apparently represent the first cross-validation of the NART-R in a sample of older Americans. These results suggest that further research on the clinical utility of the NART-R is warranted.

What is hypopnea, anyway?

Quantitation of apneas and hypopneas is routinely included in studies of epidemiology, diagnosis, and treatment of sleep-disordered breathing (SDB). The definition of apnea appears clear-cut in the sleep literature. In contrast, the literature contains remarkable variety in both recording techniques and definitions of hypopnea. The purpose of this study was to characterize the variety in the definitions and techniques used to identify hypopnea in clinical sleep laboratories. One hundred surveys were mailed to 100 accredited sleep laboratories. Each laboratory was asked to provide its criteria and equipment used to define hypopnea. Forty-five surveys (45 percent) were returned. No two laboratories used the same definition and measures of hypopnea. We conclude that there is no consensus about either recording techniques or definitions of hypopnea. Thus, epidemiologic studies and reports of interventions on SDB that do not include precise definitions of hypopnea must be interpreted with caution.

Sleep-disordered breathing in the healthy elderly. Clinically significant?

We evaluated sleep/wake, medical, and psychological parameters in a cohort of healthy men and women between 50 and 80 years of age. Consistent with previous investigations of sleep-disordered breathing (SDB) in older persons, nocturnal breathing disturbances were quite common in our normal-aged subjects, with more than 15 percent experiencing five or more SDB events per hour of sleep. However, when SDB indices were correlated with comprehensive measures of daytime functioning, the number of statistically significant relationships was at or below expectations from chance alone. Additionally, comparison of high-SDB subjects (AHI greater than or equal to 5) with low-SDB subjects (AHI less than 5) failed to reveal reliable differences on measures of daytime functioning. We conclude that SDB occurring in otherwise healthy older persons is not a cause for immediate concern, although longitudinal studies may yet demonstrate significant long-term sequelae of SDB in this population.

Nocturnal bruxing events in subjects with sleep-disordered breathing and control subjects.

Nocturnal bruxing events were recorded during a single night of sleep for 12 subjects with sleep-disordered breathing and 12 age- and sex-matched controls. The results suggest that bruxing events are very common in both groups and are closely associated with sleep arousals. There were few differences in the number, duration, or type of bruxing events between these two groups. Bruxing events were common during stage 1, stage 2, and REM sleep, while they rarely occurred during stage 3 and 4 sleep. The average duration of bruxing events ranged from 3.82 to 6.68 seconds. There was a trend toward more bruxing events occurring while sleeping on the back than on the side.

Nocturnal bruxing events in healthy geriatric subjects.

Thirty healthy geriatric subjects were studied during a single night of sleep in a sleep laboratory. Unilateral masseter muscle activity was recorded in addition to the standard polysomnographic study. The geriatric subjects in this study exhibited fewer bruxing events than other subjects reported in the literature. Certain conditions that have not been previously investigated, such as sleep position, type of bruxing event, and relationship to the state of the dentition, are reported.

Geriatric sleep apnea syndrome: a preliminary description.

We compared 8 patients diagnosed with geriatric sleep apnea syndrome (GSAS) with 12 healthy older controls (GCON) matched on age, sex, weight, education, and socioeconomic standing. GSAS was diagnosed if patients had an apnea + hypopnea index (AHI) greater than or equal to 10 and an impairment involving at least two of the following: hypertension, cardiac arrhythmias, or daytime hypersomnolence. In addition to significant differences on selection variables (e.g., AHI, frequency of hypertension, Multiple Sleep Latency Test), GSAS patients had significantly more sleep disturbance, were sleepier on subjective measures, were more depressed, and had lower scores on tests of nonverbal problem solving and nonverbal memory. Thus, GSAS resembles SAS described in middle-aged populations. More research is needed to determine the most efficient diagnostic parameters for identifying pathological levels of SDB in older persons.

Treatment of obstructive sleep apnea. A preliminary report comparing nasal CPAP to nasal oxygen in patients with mild OSA.

Nasal CPAP is presently accepted as first-line therapy for obstructive sleep apnea, but a significant minority of patients do not tolerate nasal CPAP. The purpose of this study was to compare the benefits of nasal CPAP, nasal oxygen (O2), and placebo (air) using patients as their own controls. We studied eight men, aged 33 to 72 (mean 57 years), who had mild obstructive sleep apnea. To be eligible for study, patients had to have an apnea plus hypopnea index greater than or equal to 5, plus one or more of the following: blood pressure greater than 150/95 mm Hg, multiple sleep latency test mean score less than or equal to 10 minutes, or significant nocturnal cardiac ectopy. After a baseline study, patients received a month each of nocturnal O2 at 4 LPM and air at 4 LPM, presented in random order. The third month of treatment consisted of nasal CPAP (range 2.5 to 12.5 cm H2O). Patients underwent evaluation at baseline and after each month of treatment. It was concluded that oxygen was more effective in improving oxygenation and hypopneas than is nasal CPAP. However, oxygen did not reduce apneas or improve daytime hypersomnolence as well as nasal CPAP in patients with mild OSA. Oxygen might be considered as an alternate form of treatment for patients who are not hypersomnolent, or as an adjunct to nasal CPAP.