Attorney demands for protected psychological test information: Is access necessary for cross examination or does it lead to misinformation? An interorganizational* position paper.

Objective: Some attorneys claim that to adequately cross examine neuropsychological experts, they require direct access to protected test information, rather than having test data analyzed by retained neuropsychological experts. The objective of this paper is to critically examine whether direct access to protected test materials by attorneys is indeed necessary, appropriate, and useful to the trier-of-fact. Method: Examples are provided of the types of nonscientific misinformation that occur when attorneys, who lack adequate training in testing, attempt to independently interpret neurocognitive/psychological test data. Results: Release of protected test information to attorneys introduces inaccurate information to the trier of fact, and jeopardizes future use of tests because non-psychologists are not ethically bound to protect test content. Conclusion: The public policy underlying the right of attorneys to seek possibly relevant documents should not outweigh the damage to tests and resultant misinformation that arise when protected test information is released directly to attorneys. The solution recommended by neuropsychological/psychological organizations and test publishers is to have protected psychological test information exchanged directly and only between clinical psychologist/neuropsychologist experts.

Gender and ethnic/racial diversity in clinical neuropsychology: Updates from the AACN, NAN, SCN 2020 practice and "salary survey".

OBJECTIVE: Examination of gender and diversity issues within clinical neuropsychology, using data from the 2020 professional practice and "salary survey." METHODS: Clinical neuropsychologists in the U.S. and Canada were invited to participate in an online survey. The final sample consisted of 1677 doctoral-level practitioners. RESULTS: Approximately, 60% of responding neuropsychologists are women and 53.8% of those women identify as early career psychologists (ECPs). Conversely, a majority of men in the sample are advanced career psychologists (ACPs). Both genders work predominantly in institutions, but more men than women work in private practice. ACP men produce a greater number of peer-reviewed publications and conference presentations. Across all work settings, women earn significantly less than men, and are less satisfied with their incomes. Establishing and maintaining family life is the biggest obstacle to attaining greater income and job satisfaction for both genders. Ethnic/racial minority status was identified in 12.9% of respondents, with 59.2% being ECPs. Job satisfaction and hostility in the workplace vary across ethnic/racial minority groups. Hispanic/Latino(a) and White neuropsychologists report higher incomes, but there were no statistically significant differences between any of the groups. CONCLUSIONS: Income and select practice differences persist between female and male neuropsychologists. There is a slow rate of increased ethnic/racial diversity over time, which is much more apparent among early career practitioners. Trajectories and demographics suggest that the gender income gap is unlikely to be improved by the next survey iteration in 2025, whereas it is very likely that ethnic/racial diversity will continue to increase gradually.

Forensic neuropsychology: History and current status.

Objective:This review provides a summary of historical details and current practice activities related to Forensic Neuropsychology (FN). Under the auspices of the American Board of Clinical Neuropsychology (ABCN), the Forensic Neuropsychology Special Interest Group (FNSIG) views the FN as a subspecialty, which has developed over time as the straightforward result of more than 20 years of numerous publications, extensive continuing education, focused research and growth of forensic practice within neuropsychology. In this article, the FNSIG core work group documents and integrates information that is the basis of efforts to consolidate practice knowledge and facilitate attainment of forensic practice competencies by clinical neuropsychologists. Method:Overview of continuing education topics at professional conferences, search results that identify relevant books and peer-reviewed publications, as well as pertinent findings across years of large-scale national survey results. Results:Relevant evidence has shown for decades that FN is prominent within Clinical Neuropsychology as practiced in the United States and Canada. A majority of U.S. neuropsychologists have received FN training and provide forensic evaluation services. FN practice time per week is considerable for many practitioners, and across survey epochs has been shown to be increasing. Conclusion:The present review leads to the conclusion that in the interest of promoting the acquisition of competence, FN practice should remain a focal point of training and continuing education. Alternate routes to attain competence are discussed, as are ongoing professional activities that undoubtedly will ensure continued growth of, and interest in, the subspecialty of FN.

Official position of the American Academy of Clinical Neuropsychology on test security.

To provide education regarding the critical importance of test security for neuropsychological and psychological tests, and to establish recommendations for best practices for maintaining test security in forensic, clinical, teaching, and research settings. Previous test security guidelines were not adequately specified. METHOD: Neuropsychologists practicing in a broad range of settings collaborated to develop detailed and specific guidance regarding test security to best ensure continued viability of neuropsychological and psychological tests. Implications of failing to maintain test security for both the practice of neuropsychology and for society at large were identified. Types of test data that can be safely disclosed to nonpsychologists are described.Specific procedures can be followed that will minimize risk of invalidating future use of neuropsychological and psychological measures.Clinical neuropsychologists must commit to protecting sensitive neuropsychological and psychological test information from exposure to nonpsychologists, and now have specific recommendations that will guide that endeavor.

Mentoring Journal Manuscript Reviewers Using a Competency-Based Approach: The Next Developmental Stage for the Journal of Clinical Psychology in Medical Settings.

Founded in 1994, The Journal of Clinical Psychology in Medical Settings (JCPMS) has paralleled the development of psychology's role in health care as well as contributing to its growth in science, services, and education in medical settings. JCPMS provides an essential, unique publishing outlet for health service psychology as represented by the recognized psychological specialties in those settings. At this point in its development, The Journal has turned its attention to generativity and contributing further to the field by helping prepare the next generation of journal manuscript reviewers and future psychological scientists. A brief developmental history of The Journal and its relationship to the evolution of health service psychology is offered followed by a description of a task-specific mentoring process for a new generation of manuscript reviewers. Building on work by other authors, a competency-based model is used to rearrange previously published guidance into categories of knowledge, skills, and attitudes required to become a competent manuscript reviewer. General competencies are described within each of those categories as well as specific behavioral anchors that a mentee must master in order to carry out a competent review.

Clinical neuropsychology in Canada: Results from the 2020 AACN, NAN, SCN professional practice and "salary survey".

Objective: The current study summarizes the results of a 2020 survey that solicited information regarding backgrounds, beliefs, practices, and incomes of clinical neuropsychologists who practice in Canada. Methods: Clinical neuropsychologists who practice in Canada were invited to participate in an online survey that was available from 1/17/20 to 4/02/20. Available survey findings were obtained from 111 respondents, which reflects a response rate of 51.3% of the 216 doctoral-level Canadian neuropsychologists identified in at least one major North American or international professional organization membership list (AACN, INS, NAN, or SCN). Results: Most of the current respondents were White/Caucasian women who identified as adult providers and worked full-time in urban institutional settings. Four Canadian provinces (Alberta, British Columbia, Ontario, Quebec) accounted for more than 91% of the current respondent sample. Incomes and career satisfactions were largely encouraging, though some important variations were noted by province, work setting, and professional identity. Incomes were significantly associated with forensic practices and years of clinical experience. Most respondents made use of technician support in their practices, largely to increase productivity and patient volume. Only a small minority of respondents were board-certified and there was generally limited interest in future board certification. Conclusions: While important similarities were observed in the current Canadian sample relative to recent survey findings obtained in a U.S. sample, results also reveal a number of important differences that serve as important areas of future consideration.

American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: Update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering.

Objective: Citation and download data pertaining to the 2009 AACN consensus statement on validity assessment indicated that the topic maintained high interest in subsequent years, during which key terminology evolved and relevant empirical research proliferated. With a general goal of providing current guidance to the clinical neuropsychology community regarding this important topic, the specific update goals were to: identify current key definitions of terms relevant to validity assessment; learn what experts believe should be reaffirmed from the original consensus paper, as well as new consensus points; and incorporate the latest recommendations regarding the use of validity testing, as well as current application of the term 'malingering.' Methods: In the spring of 2019, four of the original 2009 work group chairs and additional experts for each work group were impaneled. A total of 20 individuals shared ideas and writing drafts until reaching consensus on January 21, 2021. Results: Consensus was reached regarding affirmation of prior salient points that continue to garner clinical and scientific support, as well as creation of new points. The resulting consensus statement addresses definitions and differential diagnosis, performance and symptom validity assessment, and research design and statistical issues. Conclusions/Importance: In order to provide bases for diagnoses and interpretations, the current consensus is that all clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid. There is a strong and continually-growing evidence-based literature on which practitioners can confidently base their judgments regarding the selection and interpretation of validity measures.

Professional practices, beliefs, and incomes of U.S. neuropsychologists: The AACN, NAN, SCN 2020 practice and "salary survey".

OBJECTIVE: This portion of the 2020 survey updates practice information, beliefs, and income data of clinical neuropsychologists who practice within the United States. Methods: Doctoral-level neuropsychology practitioners were invited via numerous methods, with multiple reminders, to participate in a web-based survey from January 17 through April 2, 2020. The useable U.S. sample of 1677 doctoral-level practitioners was 6.2% larger than the comparable group in the prior 2015 practice survey. Results: Whereas women practitioners predominate, which continues a steeply increasing trend across time, increases in overall ethnic/racial diversity continue at a slow pace. Median age has remained very similar over the last 30 years, reflecting a continuous influx of young practitioners. A relatively small minority of neuropsychologists work part time. The proportion of board-certified neuropsychologists continues to show meaningful increase; interest in subspecialization certification is relatively high. Reliance on technicians remains popular, especially for neuropsychologists who work in institutions or are board certified. Although implementation of new CPT codes in 2019 and related payor policies appear to have had more negative than positive effects, psychology-related annual incomes of neuropsychologists have again increased compared to prior surveys. Variables such as specific work setting, state, region, years in practice, forensic practice hours, board certification, and basis for determining income (e.g. hours billed, revenue collected, relative value units) have an impact on income. More than half of practitioners engage in forensic neuropsychology, with the number of related practice hours per week again increasing. There is very high agreement regarding the use of response validity measures in clinical practice and forensic practice. Neurologists remain the number one referral source whether working in an institution, private practice, or a combination of both, and regardless of maintaining a pediatric, adult, or lifespan practice. Career satisfaction ratings for income, job, and work-life balance remain high, with the majority of ratings regarding the future of the specialty in the positive range. Additional data summaries related to a wide range of professional and practice topics are provided. Conclusions: Updating and comparing survey information at five-year intervals continues to provide insights and perspectives regarding relative stabilities and changes in practice activities, beliefs, and incomes of U.S. clinical neuropsychologists. Such information also provides guidance regarding the future of the specialty.

Professional Practices, Beliefs, and Incomes of Postdoctoral Trainees: The AACN, NAN, SCN 2020 Practice and 'Salary Survey'.

OBJECTIVE: Within a portion of the 2020 professional practice and "salary survey," to update key information regarding neuropsychology postdoctoral trainees. METHODS: Postdoctoral trainees were contacted via a variety of membership listings, including the listserv used by the program directors of the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN). Invitations sent in multiple waves to members of numerous neuropsychological organizations via e-messages and physical postcards included the request that postdoctoral trainees participate. The survey website was opened on January 17, 2020 and closed on April 2, 2020, during which time a total of 178 postdoctoral trainees in the USA and 3 in Canada participated. RESULTS: Response rate was estimated to be 56.4%, which adequately represents the target sample. The modal postdoctoral trainee is a woman whose internship was American Psychological Association (APA)-accredited and whose postdoctoral training is in an APPCN program that adheres to Houston Conference training guidelines. Extensive clinical experiences in neuropsychology in the form of externship practica and during internship were reported by the majority of trainees prior to postdoctoral training. There are few differences between APPCN and non-APPCN trainees and reported training experiences. Job satisfaction is high. Salaries appear to have increased substantially in recent years. There is universal interest in pursuing board certification. Support for the empirical foundations justifying assessment of response validity is high. CONCLUSIONS: Surveys of postdoctoral trainees continue to provide valuable perspectives regarding training background, clinical experiences, practice beliefs, and incomes of individuals who will soon launch their careers in clinical neuropsychology.

American Academy of Clinical Neuropsychology consensus conference statement on uniform labeling of performance test scores.

Objectives: Descriptive labels of performance test scores are a critical component of communicating outcomes of neuropsychological and psychological evaluations. Yet, no universally accepted system exists for assigning qualitative descriptors to scores in specific ranges. In addition, the definition and use of the term "impairment" lacks specificity and consensus. Consequently, test score labels and the denotation of impairment are inconsistently applied by clinicians, creating confusion among consumers of neuropsychological services, including referral sources, trainees, colleagues, and the judicial system. To reduce this confusion, experts in clinical and forensic neuropsychological and psychological assessment convened in a consensus conference at the 2018 Annual Meeting of the American Academy of Clinical Neuropsychology (AACN). The goals of the consensus conference were to recommend (1) a system of qualitative labels to describe results from performance-based tests with normal and non-normal distributions and (2) a definition of impairment and its application in individual case determinations. Results: The goals of the consensus conference were met resulting in specific recommendations for the application of uniform labels for performance tests and for the definition of impairment, which are described in this paper. In addition, included in this consensus statement is a description of the conference process and the rationales for these recommendations. Conclusions/Importance: This consensus conference is the first formal attempt by the professional neuropsychological community to make recommendations for uniform performance test score labels and to advance a consistent definition of impairment. Using uniform descriptors and terms will reduce confusion and enhance report comprehensibility by the consumers of our reports as well as our trainees and colleagues.

Performance validity on the Stroop Color and Word Test in a mixed forensic and patient sample.

Objective: Assessment of performance validity is an essential component of neuropsychological evaluation. Performance validity indicators contained within cognitive ability measures are particularly advantageous, as they do not require additional test administration time or material, and allow for assessment of validity across multiple cognitive domains over the course of an evaluation. The present study examined the classification accuracy of the Stroop Color and Word Test (Stroop) Word, Color, and Color-Word trials in detecting invalid performance in a mixed forensic and patient sample. Method: Archival data from a mixed-diagnosis sample were analyzed, consisting of 558 (Mage=40.8; Meducation=15.3) individuals referred for neuropsychological evaluation in clinical or forensic contexts, who completed a test battery that included the Stroop and at least two performance validity tests (PVTs). Examinees were assigned to Valid or Invalid performance groups based on PVT outcomes. Results: Word and Color scores were found to have excellent classification accuracy, whereas Color-Word yielded acceptable classification accuracy. Sensitivity and specificity values are presented for a range of cutoff scores, as are positive and negative predictive values for setting-specific base rates of invalid performance. Conclusions: Performances on the Stroop Color and Word Test, particularly the Word and Color trials, can be useful in detecting invalid performance in a mixed patient and forensic sample. Clinical implications are discussed.

Deciding to adopt revised and new psychological and neuropsychological tests: an inter-organizational position paper.

OBJECTIVE: Neuropsychological tests undergo periodic revision intended to improve psychometric properties, normative data, relevance of stimuli, and ease of administration. In addition, new tests are developed to evaluate psychological and neuropsychological constructs, often purporting to improve evaluation effectiveness. However, there is limited professional guidance to neuropsychologists concerning the decision to adopt a revised version of a test and/or replace an older test with a new test purporting to measure the same or overlapping constructs. This paper describes ethical and professional issues related to the selection and use of older versus newer psychological and neuropsychological tests, with the goal of promoting appropriate test selection and evidence-based decision making. METHOD: Ethical and professional issues were reviewed and considered. CONCLUSIONS: The availability of a newer version of a test does not necessarily render obsolete prior versions of the test for purposes that are empirically supported, nor should continued empirically supported use of a prior version of a test be considered unethical practice. Until a revised or new test has published evidence of improved ability to help clinicians to make diagnostic determinations, facilitate treatment, and/or assess change over time, the choice to delay adoption of revised or new tests may be viewed as reasonable and appropriate. Recommendations are offered to facilitate decisions about the adoption of revised and new tests. Ultimately, it is the responsibility of individual neuropsychologists to determine which tests best meet their patients' needs, and to be able to support their decisions with empirical evidence and sound clinical judgment.

Gender in clinical neuropsychology: practice survey trends and comparisons outside the specialty.

OBJECTIVE: This paper describes gender-related trends within clinical neuropsychology, based primarily on recurrent practice surveys within the specialty and, to a lesser extent, job-related information from medical specialties and the general U.S. labor market. METHOD: Chronological and cross-sectional analyses of professional practice survey data from 2005, 2010, and 2015 relevant to gender. As is common with survey data, descriptive analysis and independent samples t-tests were conducted. Longitudinal data allowed for examination of gender trends, as well as observations of change and stability of factors associated with gender, over time. RESULTS: Women have become dominant in number in clinical neuropsychology, and also comprise a vast majority of practitioners entering the specialty. Gender differences are noted in professional identity, work status, work settings, types of career satisfaction, and retirement expectations. Women are more likely to identify work environment and personal/family obstacles to aspects of career satisfaction. A gender pay gap was found at all time points and is not narrowing. As is true nationally, multiple factors appear related to the gender pay gap in clinical neuropsychology. CONCLUSIONS: Women in neuropsychology are now dominant in number, and their presence is strongly associated with specific practice patterns, such as greater institutional employment, less involvement in forensic practice, and strong involvement in pediatric practice, which may be maintaining the sizeable gender pay gap in neuropsychology. As the proportion of women neuropsychologists continues to increase, flexible work hours, and alternative means of remuneration may be needed to offset current disproportionate family-related responsibilities.

Reduced prefrontal activation during working and long-term memory tasks and impaired patient-reported cognition among cancer survivors postchemotherapy compared with healthy controls.

BACKGROUND: Patients who receive adjuvant chemotherapy have reported cognitive impairments that may last for years after the completion of treatment. Working memory-related and long-term memory-related changes in this population are not well understood. The objective of this study was to demonstrate that cancer-related cognitive impairments are associated with the under recruitment of brain regions involved in working and recognition memory compared with controls. METHODS: Oncology patients (n = 15) who were receiving adjuvant chemotherapy and had evidence of cognitive impairment according to neuropsychological testing and self-report and a group of age-matched, education group-matched, cognitively normal control participants (n = 14) underwent functional magnetic resonance imaging. During functional magnetic resonance imaging, participants performed a nonverbal n-back working memory task and a visual recognition task. RESULTS: On the working memory task, when 1-back and 2-back data were averaged and contrasted with 0-back data, significantly reduced activation was observed in the right dorsolateral prefrontal cortex for oncology patients versus controls. On the recognition task, oncology patients displayed decreased activity of the left-middle hippocampus compared with controls. Neuroimaging results were not associated with patient-reported cognition. CONCLUSIONS: Decreased recruitment of brain regions associated with the encoding of working memory and recognition memory was observed in the oncology patients compared with the control group. These results suggest that there is a reduction in neural functioning postchemotherapy and corroborate patient-reported cognitive difficulties after cancer treatment, although a direct association was not observed. Cancer 2016;122:258-268. © 2015 American Cancer Society.

The American Academy of Clinical Neuropsychology, National Academy of Neuropsychology, and Society for Clinical Neuropsychology (APA Division 40) 2015 TCN Professional Practice and 'Salary Survey': Professional Practices, Beliefs, and Incomes of U.S. Neuropsychologists.

OBJECTIVE: The current survey updated professional practice and income information pertaining to clinical neuropsychology. METHODS: Doctoral-level members of the American Academy of Clinical Neuropsychology, Division 40 (Clinical Neuropsychology) of the American Psychological Association, and the National Academy of Neuropsychology and other neuropsychologists, as well as postdoctoral trainees in the Association of Postdoctoral Programs in Clinical Neuropsychology and at other training sites were invited to participate in a web-based survey in early 2015. The sample of 1777 respondents, of whom 1579 were doctoral-level practitioners and 198 were postdoctoral trainees, was larger than the prior 2010 income and practice survey. RESULTS: The substantial proportional change in gender has continued, with women now a clear majority in the postdoctoral trainee sample as well as in the practitioner sample. Dissimilar from the median age trajectory of American Psychological Association members, the median age of clinical neuropsychologists remains essentially unchanged since 1989, indicating a substantial annual influx of young neuropsychologists. The question of whether the Houston Conference training model has become an important influence in the specialty can now be considered settled in the affirmative among postdoctoral trainees and practitioners. Testing assistant usage remains commonplace, and continues to be more common in institutions. The vast majority of clinical neuropsychologists work full-time and very few are unemployed and seeking employment. The numbers of neuropsychologists planning to retire in the coming 5-10 years do not suggest a "baby boomer" effect or an unexpected bolus of planned retirements in the next 10 years that would be large enough to be worrisome. Average length of time reported for evaluations appears to be increasing across time. The most common factors affecting evaluation length were identified, with the top three being: (1) goal of evaluation, (2) stamina/health of examinee, and (3) age of examinee. Pediatric specialists remain more likely than others to work part-time, more likely to work in institutions, report lower incomes than respondents with a lifespan professional identity, and are far more likely to be women. Incomes continue to vary considerably by years of clinical practice, work setting, amount of forensic practice, state, and region of country. Neurologists are the number one referral source in institutions and in private practice, as well as for pediatric, adult, and lifespan practitioners. Learning disability is no longer among the top five conditions seen by pediatric neuropsychologists; traumatic brain injury and seizure disorder are common reasons for clinical evaluations at all age ranges. There is a continued increase in forensic practice and a clear consensus on the use of validity testing. There is a substantial interest in subspecialization board certification, with the greatest interest evident among postdoctoral trainees. Income satisfaction, job satisfaction, and work-life balance satisfaction are higher for men. Job satisfaction varies across general work setting and across age range of practice. Work-life balance satisfaction is moderately correlated with income satisfaction and job satisfaction. Again in this five-year interval survey, a substantial majority of respondents reported increased incomes, despite experiencing substantial negative practice effects related to changes in the US health care system. Numerous breakdowns related to income and professional activities are provided. CONCLUSIONS: Professional practice survey information continues to provide valuable perspectives regarding consistency and change in the activities, beliefs, and incomes of US clinical neuropsychologists.

Twenty years of the Journal of Clinical Psychology in Medical Settings: we hope you will enjoy the show.

The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal-to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings-is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.

Prospective longitudinal evaluation of a symptom cluster in breast cancer.

CONTEXT: Symptom cluster research expands cancer investigations beyond a focus on individual symptoms in isolation. OBJECTIVES: We conducted a prospective longitudinal study of sleep, fatigue, depression, anxiety, and perceived cognitive impairment in patients with breast cancer undergoing chemotherapy. METHODS: Patient-reported outcome measures were administered prior to chemotherapy, at Cycle 4 Day 1, and six months after initiating chemotherapy. Participants were divided into four groups and assigned a symptom cluster index (SCI) score based on the number/severity of symptoms reported at enrollment. RESULTS: Participants (N = 80) were mostly women (97.5%) with Stage II (69.0%) breast cancer, 29-71 years of age. Scores on all measures were moderately-highly correlated across all time points. There were time effects for all symptoms, except sleep quality (nonsignificant trend), with most symptoms worsening during chemotherapy, although anxiety improved. There were no significant group × time interactions; all four SCI groups showed a similar trajectory of symptoms over time. Worse performance status and quality of life were associated with higher SCI score over time. CONCLUSION: With the exception of anxiety, the coherence of the symptom cluster was supported by similar patterns of severity and change over time in these symptoms (trend for sleep quality). Participants with higher SCI scores prior to chemotherapy continued to experience greater symptom burden during and after chemotherapy. Early assessment and intervention addressing this symptom cluster (vs. individual symptoms) may have a greater impact on patient performance status and quality of life for patients with higher SCIs.

Traumatic brain injury: guidance in a forensic context from outcome, dose-response, and response bias research.

Traumatic brain injury (TBI) occurs at a high incidence, involving millions of individuals in the U.S. alone. Related to this, there are large numbers of litigants and claimants who are referred annually for forensic evaluation. In formulating opinions regarding claimed injuries, the present review advises experts to rely on two sets of information: TBI outcome and neuropsychological dose-response studies of non-litigants and non-claimants, and response bias literature that has demonstrated the relatively high risk of invalid responding among examinees referred within a secondary gain context, which in turn has resulted in the development of specific assessment methods. Regarding prospective methods for detecting possible response bias, both symptom validity tests, for measuring over-reporting of symptoms on inventories and questionnaires, and performance validity tests, for measuring insufficient effort on ability tests, are considered essential.