The validity of the test of memory malingering (TOMM) with deaf individuals.

OBJECTIVE: Administration of performance validity tests (PVT) during neuropsychological assessments is standard practice, with the Test of Memory Malingering (TOMM) being a commonly used measure. The TOMM has been well validated in hearing populations with various medical and psychiatric backgrounds. A major gap in the literature is the use of the TOMM amongst culturally Deaf individuals who use American Sign Language (ASL) as their first and preferred language. The purpose of this study was to explore the use of the TOMM with this population to determine if there may be differences related to the use of semantic knowledge and recall using signs rather than spoken phonemes. METHOD: This study recruited 30 culturally Deaf, community-dwelling adults, who self-reported that they were not involved in litigation ordisability claims. In addition to the TOMM, participants were screened for cognitive ability using non-verbal components of the Wechsler Abbreviated Scale of Intelligence, Second Edition (WASI-II) and the Mini Mental State Examination: ASL Version (MMSE:ASL). RESULTS: Nonverbal intelligence for this sample was within the average range of ability. No participants scored lower than the standard cut-off score for Trial 2 or the Retention Trial on the TOMM (≤44 raw score to indicate invalid responding). Trial 1 performances ranged from 44 to 50, Trial 2 performances ranged from 49 to 50, and Retention performances ranged from 49 to 50. CONCLUSION: These results support the use of the same standard cut-off scores established for hearing individuals in culturally Deaf individuals who use ASL.

Influence of poor effort on self-reported symptoms and neurocognitive test performance following mild traumatic brain injury.

When considering a diagnosis of postconcussion syndrome, clinicians must systematically evaluate and eliminate the possible contribution of many differential diagnoses, comorbidities, and factors that may cause or maintain self-reported symptoms long after mild traumatic brain injury (MTBI). One potentially significant contributing factor is symptom exaggeration. The purpose of the study is to examine the influence of poor effort on self-reported symptoms (postconcussion symptoms and cognitive complaints) and neurocognitive test performance following MTBI. The MTBI sample consisted of 63 referrals to a concussion clinic, evaluated within 5 months post injury (M = 2.0, SD = 1.0, range = 0.6-4.6), who were receiving financial compensation from the Workers' Compensation Board. Participants completed the Post-Concussion Scale (PCS), British Columbia Cognitive Complaints Inventory (BC-CCI), selected tests from the Neuropsychological Assessment Battery Screening Module (S-NAB), and the Test of Memory Malingering (TOMM). Participants were divided into two groups based on TOMM performance (15 fail, 48 pass). There were significant main effects and large effect sizes for the PCS (p = .002, d = 0.79) and BC-CCI (p = .011, d = 0.98) total scores. Patients in the TOMM fail group scored higher than those in the TOMM pass group on both measures. Similarly, there were significant main effects and/or large effect sizes on the S-NAB. Patients in the TOMM fail group performed more poorly on the Attention (p = .004, d = 1.26), Memory (p = .006, d = 1.16), and Executive Functioning (p > .05, d = 0.70) indexes. These results highlight the importance of considering the influence of poor effort, in conjunction with a growing list of factors that can influence, maintain, and/or mimic the persistent postconcussion syndrome.

"Good old days" bias following mild traumatic brain injury.

A small percentage of people with a mild traumatic brain injury (MTBI) report persistent symptoms and problems many months or even years following injury. Preliminary research suggests that people who sustain an injury often underestimate past problems (i.e., "good old days" bias), which can impact their perceived level of current problems and recovery. The purpose of this study was to examine the influence of the good old bays bias on symptom reporting following MTBI. The MTBI sample consisted of 90 referrals to a concussion clinic (mean time from injury to evaluation = 2.1 months, SD = 1.5, range = 0.8-8.1). All were considered temporarily fully disabled from an MTBI and they were receiving financial compensation through the Worker's Compensation system. Patients provided post-injury and pre-injury retrospective ratings on the 16-item British Columbia Post-concussion Symptom Inventory (BC-PSI). Ratings were compared to 177 healthy controls recruited from the community and a local university. Consistent with the good old bays bias, MTBI patients retrospectively endorsed the presence of fewer pre-injury symptoms compared to the control group. Individuals who failed effort testing tended to retrospectively report fewer symptoms pre-injury compared to those patients who passed effort testing. Many MTBI patients report their pre-injury functioning as better than the average person. This can negatively impact their perception of current problems, recovery from injury, and return to work.