Theses and Dissertations

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Date of Award


Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Psychology (PhD)


Center for Psychological Studies

First Advisor

Charles Golden

Second Advisor

David Reitman

Third Advisor

Christian DeLucia


Malingering, Neuropsychology, Testing


Clinicians have a small number of measurement instruments available to them to assist in the identification of suboptimal effort during an evaluation, which is largely agreed upon as a necessary component in the identification of malingering. Green's Medical Symptom Validity Test is a forced-choice test that was created to assist in the identification of suboptimal effort. The goal of this study was to provide clinical evidence for the validity of the Medical Symptom Validity Test using a large, archival clinical sample. The Test of Memory Malingering and the Medical Symptom Validity Test were compared to assess for level of agreement, and were found to agree in their identification of good or poor effort in approximately 75% of cases, which was lower than expected. Scores from the Medical Symptom Validity Test's effort subtests were tested for differences between adult litigants and clinically referred adults. Scores between these groups were different, and it was found that adult litigants obtained scores that were statistically significantly lower than those in the clinical group. Additionally, children were able to obtain results on the Medical Symptom Validity Test subtests that were equivalent to those of adults. Finally, the Wechlser Memory Scales - Third Edition core memory subtests were assessed for their ability to predict outcomes on the Medical Symptom Validity Test Delayed Recognition subtest. This analysis of the adult litigants and adult clinical groups revealed that, collectively, the predictors explained approximately one-third of the variance in scores on the Delayed Recognition subtest. Outcomes from these hypotheses indicated that the Medical Symptom Validity Test was measuring a construct similar to that of the Test of Memory Malingering. Due to the lower than expected level of agreement between the tests, it is recommended that clinicians use more than one measure of effort, which should increase the reliability of poor effort identification. Due to their lower scores the effort subtests, adults similar to those in the adult litigants group can be expected to perform more poorly than those who are clinically referred. Because effort subtest scores were not affected by cognitive or developmental domains, clinically referred children or adult examinees can be expected to obtain scores above cutoffs, regardless of mean age, IQ, or education. Additionally, an examinee's memory will not impact outcome scores on the effort subtests of the Medical Symptom Validity Test. Further research is needed to understand the Medical Symptom Validity Test's ability to accurately identify poor effort with minimal false positives, examine the impact of reading ability on effort subtests, and compare simulators' outcomes to those of a clinical population.

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