False Positive Diagnosis of Malingering Due to the Use of Multiple Effort Tests.

Author(s)

Lena Berthelson, Nova Southeastern University
Siddika S. Mulchan, Nova Southeastern University
Anthony P. Odland, Emory University School of Medicine
Lori J. Miller, Eastern Washington University
Wiley Mittenberg, Nova Southeastern UniversityFollow

Document Type

Article

Publication Title

Brain Injury

ISSN

0269-9052

Publication Date

2013

Abstract

OBJECTIVE:

Effort indicators are used to determine if neuropsychological test results are valid measures of a patient's cognitive abilities. The use of multiple effort measures is often advocated, but the false positive rate for multiple indicators depends on the number of measures used and the correlation among indicators. This study presents a meta-analysis of correlations among effort measures. False positive rates for multiple correlated indicators are then estimated using Monte Carlo simulations.

METHODS:

a literature search of published studies identified 22 independent samples in which 407 correlations among 31 effort measures were available in 3564 participants with normal effort. Participants were patients with neurological or psychiatric disorders and healthy volunteers.

RESULTS:

Meta-analysis showed a mean correlation among effort indicators of 0.31. Monte Carlo simulation based on a 15% false positive rate for individual indicators showed that, when 10 effort indicators are used together, 38% of patients with valid performance will be incorrectly identified as malingering if two failures is the diagnostic standard. Failure on five of 10 measures is required for a false positive rate of 10% or less. If five effort indicators are interpreted, a false positive rate of 19% results when two test failures are assumed to characterize poor effort and failure on three measures is required to maintain 90% specificity.

CONCLUSIONS:

False positive rates for effort tests increase significantly as the number of indicators that are administered is increased.

DOI

10.3109/02699052.2013.793400

Volume

27

Issue

7-8

First Page

909

Last Page

916

NSUWorks Citation

Berthelson, L., Mulchan, S. S., Odland, A. P., Miller, L. J., Mittenberg, W. (2013). False Positive Diagnosis of Malingering Due to the Use of Multiple Effort Tests.. Brain Injury, 27(7-8), 909-916.
Available at: https://nsuworks.nova.edu/cps_facarticles/219