The Alertness subtest of the Test of Attention Performance is widely used in German-speaking countries. Researchers have repeatedly proposed standard deviations (SDs) of reaction time as an embedded measure of performance validity. Using a civil forensic neuropsychological sample of 224 patients, I conducted a receiver operating characteristics analysis with the criterion standard of at least two positive results among the following validity tests: Test of Memory Malingering, Medical Symptom Validity Test, Reliable Digit Span, Reliable Spatial Span, and Rey Complex Figure Test indicators. At 90 % specificity, the resulting cutoff scores were >128 ms (SD of reaction times without warning sound) and >110 ms (with warning sound), yielding sensitivity estimates of 49 % and 53 %, respectively. I examined the false-positive rates in bona fide neuropsychological inpatients using a sample of 987 clinical cases, dividing patients into those with substantial cognitive impairment (Mini-Mental State Examination scores below 24, n = 109) and those without substantial impairment (scores of 24 or above, n = 875). For the first group, I observed high false-positive rates (35.8 % and 37.6 %), whereas the rates were considerably lower in the latter group (9.9 % and 13.4 %, respectively). The results suggest that the SDs of reaction time represent a promising indicator for validity assessment. However, as with several other embedded validity measures, a major limitation is the elevated risk of misclassifying patients with genuine, substantial neurocognitive impairment, potentially leading to their test profiles being incorrectly deemed invalid. Qualified determinations of performance validity are complex and should not rely solely on the interpretation of individual test scores.

BACKGROUND:Failure on symptom validity tests may occur in a variety of contexts and situations, including routine clinical settings. To date, no meta-analysis has targeted the failure rate of the Structured Inventory of Malingered Symptomatology (SIMS) in clinical assessments, nor the factors that may moderate this rate. METHOD:We used a binomial-normal random-effects meta-analysis to estimate the pooled failure rate of SIMS among patients with a clinical diagnosis who were evaluated in a non-forensic setting. RESULTS:34 studies and 40 samples were included. The total sample size was 8844 patients. The mean total SIMS score was 15.9 (SD = 5.2). The estimated overall failure rate of SIMS was 36% (95% CI: 30%-43%; I 2 = 96.6%, p < .001). CONCLUSIONS:There is an elevated failure rate on the SIMS in clinical patient populations; however, these positive results are not necessarily false positives. The methodological challenge to tell true and false positives apart appears to be of primary importance and should dictate both careful planning of future studies and circumspection when interpreting rates of validity test failure in clinical assessments.

The estimated base rate or prevalence of malingering and related attributions, for example, invalid response set, is a critical issue in forensic disability and related assessment (FDRA). There are two major estimates in the field on the question: 40 ± 10

The subjective nature of pain complicates objective verification, often leading to noncredible symptom reports in compensable settings. Across two studies, we evaluated the Italian Self-Report Symptom Inventory (SRSI-It) in distinguishing healthy individuals, simulators, and fibromyalgia patients. In Study 1, we assigned 958 participants to the honest (n = 482) or simulator group (n = 476). Simulators reported higher scores on genuine and pseudosymptoms. A cut score > 6 showed 92% specificity and 64% sensitivity; > 9 raised specificity to 95%. The SRSI-It identified 62% and 58% of simulators at > 6 and > 9, respectively, compared to 76% identified by the SIMS. In Study 2, we recruited 100 patients and paired each with a healthy control and a fibromyalgia simulator (N = 300). Simulators scored highest on pseudosymptoms, while patients scored higher than controls. The SRSI-It identified 73% and 61% of simulators at cut scores of > 6 and > 9, compared to 51% and 34% of patients and 15% and 13% of controls. The SRSI-It demonstrated sensitivity to simulated pain, suggesting its utility in distinguishing simulators from honest respondents in clinical and forensic settings. However, caution is warranted to avoid misclassifying genuine patients, highlighting the need for complementary tools.

Objective: The analysis of risk of bias in systematic reviews (SR) and meta-analyses (MA) is a fundamental task to ensure the correct synthesis of results. To carry out this task, specific tools must be used for each research design of the studies analyzed. The choice of an appropriate tool is currently a challenge for researchers developing SR and MA in the area of symptom and performance validity because the research designs used have been created specifically for this field. Although these designs can be integrated within the classic classifications, they present a number of particular characteristics that are not reflected in any of the current risk of bias analysis tools. The aim of this study is to design a checklist specifically for systematic review/meta-analysis focused on validity tests. Methods: The checklist was developed through objective review of the existing evidence, development of checklist items, and refinement by external feedback and performance analysis. Results: The checklist is composed of four sections: Clinical comparison group selection, sources of bias in either simulation or criterion group designs, and overall assessment of the study. Inter-rater reliability was assessed with a sample of 20 studies, resulting in good to excellent intraclass correlation coefficients for most items. Conclusions: The checklist seeks to fill an important gap in the literature by serving as an assessment tool that improves the reliability of evidence synthesis in symptom and performance validity studies. This instrument facilitates the development of SR and MA that meet international standards, improving methodological rigor and reliability in the forensic setting.

Objective: The purpose of this American Academy of Clinical Neuropsychology (AACN) best practices paper is to provide the neuropsychological community with the fundamentals of a competent forensic review of records. Method: Narrative review addressing fundamental factors related to review of records. Examples highlighted information necessary for a forensic determination of traumatic brain injury (TBI), and the data from records that can be used to address questions regarding validity of presentation. International and intra-jurisdictional perspectives within the US were used to illustrate the necessity of adhering the review to the rules. Results: Factors identified involve ethical responsibilities, completeness in obtaining and reviewing relevant records, evaluation of credibility of the records, considerations regarding examinee self-reporting, grounding of opinions within peer-reviewed science, determination of causation in the context of litigation, and avoiding bias in reporting, as well as consideration of cultural and language factors. Different jurisdictional rules require close attention. Conclusions: Neuropsychologists need to be aware of the need for a competent review of records to obtain basic facts, maintain objectivity, and provide a context for conclusions in a neuropsychological examination report. In litigation cases, opinions based solely on review of records may be challenged for reasons that might include not having personally evaluated the plaintiff, and whether opinions meet Daubert criteria pertaining to sufficient scientific bases and facts. A thorough review in the context of examination helps deal with litigant/claimant subjectivity and malleability of self-report, and it can provide critical reasoning about other factors relevant to causation.

Tailor-made forced-choice validity testing was introduced in the 1970s and 1980s as a method to investigate cases of suspected malingering, but with the widespread use of standardized performance validity tests it seems to have lost much of its attraction. This is the case report of claimed complete visual loss in a constellation where ophthalmologists had excluded an underlying ocular disease for years, with the exception of scars after unilateral retinal detachment. The 50-year-old claimant had undergone a court-ordered psychiatric evaluation that confirmed the presence of a dissociative blindness and recommended to legally treat the claimant like a case of genuine blindness. The judge of a state court-of-appeal finally ordered a neuropsychological evaluation to clarify the true nature of the claimed blindness. Four different tailor-made forced-choice tests were constructed. On all of them, the claimant scored significantly below chance and demonstrated that, in fact, he was able to recognize the visual stimuli used on the tests. Taylor-made forced-choice procedures attract little attention in the current neuropsychological literature, but they offer a powerful approach to differential diagnosis in specific symptom constellations for which standardized testing is not available. Unclear symptom constellations like in this case can be resolved by tailor-made testing.

Self-report on symptomatology and history is an indispensable data source in the diagnostic process, but overreliance on it, in neglect of objective data, is a major source of error. Diagnostic error with subsequent wrong treatment and potential harm remains a pervasive problem in medicine in general, and in mental healthcare in particular. The text provides a short review of self-report bias and a number of other judgmental biases that are haunting current assessment and treatment practices.

ObjectivesCompared to the number of performance validity measures, the range of available symptom validity measures is limited. The Self-Report Symptom Inventory (SRSI) is a recently developed freestanding symptom validity test with promising psychometric characteristics for use on non-criminal forensic and a range of clinical populations. The goal of this study was to evaluate the utility of the SRSI for symptom validity testing in the clinical evaluation of adults with attention-deficit/hyperactivity disorder (ADHD).MethodsThis analogue study compared 76 German patients diagnosed with ADHD (age range 19-63 years) with typically developing individuals from the Netherlands/Germany who were assigned to either a control group (N = 58; age range 18-73 years) or a simulation group (N = 46; age range 18-57 years). All participants completed the Conners' Adult ADHD Rating Scale (CAARS) with its two embedded validity indicators Infrequency Index (CII) and ADHD Credibility Index (ACI), the SRSI, and the Digit Span (to derive the Reliable Digit Span).ResultsSpecificity in controls was perfect for the CAARS, but reached only about 90% for the SRSI. In contrast, sensitivity in experimental simulators ranged from 24% to 65% for the CAARS, but reached high rates of 69% to 82% for the SRSI. In the sample of patients with ADHD, the failure rate ranged from 8% to 34% (CAARS), and 33% to 47% (SRSI). Further, we found limited classification agreement between the validity measures.ConclusionThe divergent results on the different validity indicators reflects the ongoing discussion on poor construct unity and clarity, and calls for more research addressing the heterogeneous construct. The utility of the SRSI to reliably distinguish between valid and invalid symptom report in the clinical evaluation of adult ADHD has to be investigated by more refined studies including both symptom and performance validity indicators.

The Self-Report Symptom Inventory (SRSI) is a novel tool designed to detect symptom overreporting and other forms of noncredible responding. Unlike existing scales, the SRSI includes genuine and pseudosymptoms scales covering cognitive, affective, motor, pain, and post-traumatic stress disorder domains. The present study aims to investigate the psychometric properties of the Italian Version of the SRSI (SRSI-It), in particular, its factor structure, reliability, convergent and discriminant validity, and diagnostic accuracy. Data from 1180 healthy participants showed a hierarchical structure with higher-order constructs for genuine symptoms and pseudosymptoms, each comprising five subscales. The SRSI-It showed a strong convergent validity with the Structured Inventory of Malingered Symptomatology and discriminant validity through low correlations with the Psychopathic Personality Inventory-Revised. Receiver operating characteristic analysis determined cut scores of 6 (95% specificity) and 9 (98% specificity) for pseudosymptoms, with a Ratio Index score of 0.289 (82% specificity). In summary, the SRSI-It appears to be a promising tool for identifying symptom exaggeration in clinical and forensic contexts, ultimately enhancing the quality and reliability of evaluations in these contexts.

This archival study sought to determine whether psychological reports adequately communicate the results of Symptom Validity Tests (SVTs) and Performance Validity Tests (PVTs). We collected reports from a pool of 469 clinical psychological and neuropsychological assessments conducted across five Dutch hospitals. To be included, the administered SVT (i.e., Structured Inventory of Malingered Symptomatology; SIMS) and/or PVT (Amsterdam Short-Term Memory test, ASTM) needed to be either passed or failed. Additionally, we selected reports from psychologists who, prior to conducting the assessments, anticipated either problematic or unproblematic validity. A total of 146 reports (57 clinical psychological and 89 neuropsychological reports), authored by 36 psychologists from five different hospitals, were analyzed. Invalid range scores on SIMS and/or ASTM occurred in 48% of the sample. Two researchers independently reviewed and coded reports, resolving mismatches through consensus and crosschecking with original test data. The majority of clinical psychological reports (89.5%) did not reference the SIMS or accurately describe the SIMS results, despite its use. In contrast, most neuropsychological reports mentioned the SIMS and ASTM, and adequately described their results (77.5%). Approximately half of the reports with invalid range scores on these instruments included interpretative statements, often suggesting overreporting and/or underperformance. In about one-third of cases, a fail on the validity test was attributed to factors such as anxiety, fatigue, depression, or pain. Other cognitive tests and psychological questionnaires were frequently interpreted without considering these invalid scores. Treatment recommendations seldom took SVT/PVT fails into account. The findings indicate that a non-negligible number of reports do not accurately report and discuss SVT/PVT results, underscoring the need for enhancing the quality and precision of psychological reports concerning validity testing.

Background/Objective: The area of malingering has advanced in recent years in Spain. However, a boost is still needed to reach and harness international resources and standards. It is of great importance to have guidelines and reviews that can incorporate and adapt recent evidence to the Spanish context. Our aim is to review the literature on malingering and related concepts, in the Spanish forensic-psychological context. In addition, an updated working guide for professionals in the context will be offered. Method: A bibliographic review of the national and international literature was carried out. Results: A series of limitations in terminology have been identified, for which we propose several suggestions that are coherent with the international literature. Similarly, we propose a complete evaluation system, from hypothesis formulation to components and conclusions, oriented towards forensic professional practice. Conclusions: The current state of Spanish literature in this area shows shortcomings that make it difficult to reach the standards of good practice. It is important to promote the adaptation of new tests and the development of research with those that have already been adapted, in new contexts and populations of interest.

When patients fail symptom validity tests (SVTs) and/or performance validity tests (PVTs), their self-reported symptoms and test profiles are unreliable and cannot be taken for granted. There are many well-established causes of poor symptom validity and malingering is only of them. Some authors have proposed that a cry for help may underlie poor symptom validity. In this commentary, we argue that cry for help is a (1) metaphorical concept that is (2) difficult to operationalize and, at present, (3) impossible to falsify. We conclude that clinicians or forensic experts should not invoke cry for help as an explanation for poor symptom validity. To encourage conceptual clarity, we propose a tentative framework for explaining poor symptom validity.

Some recent studies have revived the approach of investigating extreme levels of self-reported depressive symptoms as indicative of gross exaggeration. While scores above 40 on the Beck Depression Inventory-Second Edition (BDI-II) were discussed as indicating exaggerated symptom claims, different cut scores for identifying noncredible responding are now being discussed. A consecutive sample of 242 patients referred for forensic psychological assessment (mean age: 46.0 years, 47.7% women) with full data sets on the BDI-II and the Structured Inventory of Malingered Symptomatology (SIMS) were assessed. Of all patients, 13.2% scored above 40 and BDI-II scores correlated with SIMS total scores at .62. For different SIMS cutoffs (>14, >16, >19, >23) used as criterion standard, optimal cut scores for the BDI-II were computed. When specificity was set at a minimum of 90%, sensitivity estimates were below 50% for all four SIMS levels. Extreme scores on the BDI-II should raise concern about the credibility of self-reported depressive symptom load. Diagnosis as well as severity estimates should not be based primarily on self-report instruments. To avoid significant risks of bias, the development of reliable cut scores for BDI-II elevations should be based on more studies with samples from diverse contexts.

Questionnaire-based symptom validity tests (SVTs) are an indispensable diagnostic tool for evaluating the credibility of patients' claimed symptomatology, both in forensic and in clinical assessment contexts. In 2019, the comprehensive professional manual of a new SVT, the Self-Report Symptom Inventory (SRSI), was published in German. Its English-language version was first tested in the UK. This experimental analogue study investigated 20 adults simulating minor head injury symptoms and 21 honestly responding participants. The effect sizes of differences between the two groups were large, with the simulating group endorsing a higher number of pseudosymptoms, both on the SRSI and the Structured Inventory of Malingered Symptomatology, and scoring lower on the Reliable Digit Span than the control group. The results are similar to those obtained in previous research of different SRSI language versions, supporting the effort to validate the English-language SRSI version.