Test Validity and Patient/Symptom Validity in Neuropsychological Assessment


Glenn Larrabee, Ph.D.
Sarasota Memorial Health Care System, USA

Course Prerequisites:  

Basic familiarity with the core areas of evaluation in neuropsychological assessment, and with some of the more widely-used procedures such as the Wechsler Scales of Intelligence, the California Verbal Learning Test, and the MMPI-2.  A useful reference is Lezak, Howieson & Loring, Neuropsychological Assessment, 4th edition, published by Oxford University Press, 2004.

Course Description:  

  The first half of the lectures will be devoted to issues of neuropsychological test validity, including construct and criterion validity of neuropsychological test procedures. I will review some of the history of neuropsychological assessment in North America, and discuss how modern neuropsychological has been influenced by psychometrics, behavioral neurology, and cognitive neurology. Factor analytic results will be used to define key constructs/domains of neuropsychological assessment, and data will be presented showing the relationship of these constructs to various criteria including the effects of normal aging, effects of head trauma severity, dementia severity, and relationship to various competencies in dementia. Neuropsychological test interpretation strategies emphasizing consistency of results within and between test domains and with external criteria will be considered, with the goal of reducing judgmental biases in test interpretation.

     The second half of the lectures will be devoted to evaluation of the symptom validity of the individual patient, which is a major concern in forensic neuropsychological evaluation. The definition of malingering will be reviewed, including discussion of the Slick et al. (1999) diagnostic criteria for malingering. Statistics on the frequency of malingering will be reviewed. Assessment of malingering will be discussed, including use of free-standing and embedded measures of malingering, as well as measures of symptom exaggeration on tests such as the MMPI-2 and pain scales. Statistical support is provided for a multiple-indicator model of malingering, that maximizes sensitivity (i.e. true positive identification) and specificity (i.e. minimizing false positive identification).

Reading List

 

As a general reference (and not to be read cover-to-cover): Lezak, M.D., Howieson, D.B., & Loring, D.W. (2004). Neuropsychological Assessment. 4^th edition. New York: Oxford University Press.

 

Dikmen, S.S., Machamer, J.E., Winn, H.R., & Temkin, N.R. (1995). Neuropsychological outcome at 1-year post head injury. Neuropsychology, 9, 80-90.

 

Larrabee, G.J., Largen, J.W., & Levin, H.S.  (1984). Sensitivity of age-decline resistant (“hold”) WAIS subtests to Alzheimer’s disease. Journal of Clinical and Experimental Neuropsychology, 7, 497-504.

 

Larrabee, G.J. (2000). Association between IQ and neuropsychological test performance: Commentary on Tremont, Hoffman, Scott and Adams (1998). The Clinical Neuropsychologist, 14, 139-145.  pdf

 

Larrabee, G.J. (2003). Detection of symptom exaggeration on the MMPI and MMPI-2 in litigants with malingered neurocognitive dysfunction. The Clinical Neuropsychologist, 17, 54-68.  pdf

 

Larrabee, G.J. (2003). Detection of malingering using atypical performance patterns on standard neuropsychological tests. The Clinical Neuropsychologist, 17, 410-425.  pdf

 

Larrabee, G.J. (Ed.) (2005). Forensic Neuropsychology. A Scientific Approach. New York: Oxford University Press. The following chapters are particularly pertinent: Chapter 1 (Larrabee, A Scientific Approach to Forensic Neuropsychology), Chapter 4 (Larrabee, Assessment of Malingering), and Chapter 11 (Marson & Hebert, Assessing Civil Competencies in Older Adults with Dementia: Consent Capacity, Financial Capacity, and Testamentary Capacity).

 

Slick, D.J., Sherman, E.M.S., & Iverson, G.L. (1999). Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research. The Clinical Neuropsychologist, 13, 545-561.  pdf