Assessment of Feigned Cognitive Impairment: A Neuropsychological Perspective

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Comprehensive and user friendly, this book synthesizes the growing literature on symptom feigning in cognitive testing and translates it into evidence-based recommendations for clinical and forensic practice. A wide range of cognitive effort assessment techniques and strategies are critically reviewed, including both dedicated measures and the use of embedded indicators in standard clinical tests. The book describes approaches to distinguishing between credible and noncredible performance in specific clinical populations: persons presenting with head injury, chronic pain and fatigue, attention-deficit/hyperactivity disorder and learning disability, mental retardation, seizures, and exposure to environmental toxins. Special topics include the potentially confounding effects of psychiatric disorder and ethnocultural factors on effort testing, and cognitive assessment in the criminal forensic setting.

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Editorial Reviews

International Journal of Emergency Mental Health

"Provide[s] useful psychometric strategies and clinical wisdom for uncovering and dealing with malingered neuropsychological performance....Special strengths...include how to retool standard neuropsychological tests to be utilized as malingering-detectors....Recommended for serious neuropsychological practitioners....The tools and techniques provided...will give neuropsychological practitioners a head start in maintaining the credibility of our evaluations and—just as important—assuring that patients receive proper clinical care."--International Journal of Emergency Mental Health
From the Publisher

"This is an excellent book that provides state-of-the-art perspectives on assessing and determining noncredible neuropsychological performance. The book suggests advances beyond the pejorative and sometimes simplistic term 'malingering,' looking instead at both conscious and nonconscious motives for poor performance. Contributors review an astonishing array of techniques and strategies for detecting noncredible performance on symptom validity tests and clinical measures. Proposing novel nomenclature and conceptual thinking, this volume will help move the field forward in this important area of research and practice."--Wilfred G. van Gorp, PhD, Department of Psychiatry, Columbia University College of Physicians and Surgeons

"This comprehensive work features contributions by many of the best-known people in the field. Covering assessment of diverse groups--including persons with psychogenic seizures, criminal forensic examinees, and cultural and linguistic minority group members--this will be a useful text for graduate-level courses and a resource for practicing clinicians."--Laurence M. Binder, PhD, Departments of Psychiatry and Neurology, Oregon Health and Science University

"Boone and her colleagues effectively review a large selection of clinical circumstances that require neuropsychological assessment of feigned cognitive impairment, and thoroughly examine a broad range of tests used for that purpose. The book is filled with thoughtful exploration of current issues attending assessment of feigning. This comprehensive text will become an essential reference for neuropsychologists and other forensic clinicians, and will serve well as a textbook for graduate-level courses in neuropsychological assessment."--Richard I. Frederick, PhD, United States Medical Center for Federal Prisoners, Springfield, Missouri
"Boone is well known for her innovative research on assessment of response bias, making her an ideal editor for this comprehensive volume. The section on effort testing in various clinical populations is important, for it focuses not only on feigned impairment in different clinical disorders, but also on correct identification of legitimately impaired patients who are manifesting valid test performance. This book will be a valuable asset to the practicing clinician, and it is also appropriate for use as a text in advanced graduate and postdoctoral clinical training."--Glenn J. Larrabee, PhD, private practice, Sarasota, Florida

Journal of the American Academy of Psychiatry and the Law

"A timely publication. Although its intended audience is practicing psychologists and graduate students, Boone's book will help forensic psychiatrists become better informed consumers of neuropsychological effort testing. Boone and the contributing authors describe new research in three key areas: novel instruments for detecting deigned cognitive deficits; psychometric properties of existing instruments; and existing psychological tests used to describe performance patterns that are specific to malingering....The topic of neuropsychological effort testing can admittedly be a daunting one. Fortunately, this book presents it in a highly comprehensive manner. Boone and her collaborators have synthesized recent scientific advances in the area of effort testing into a text that will become an invaluable tool for all practitioners who rely on neuropsychological testing data."--Journal of the American Academy of Psychiatry and the Law
Journal of Police and Criminal Psychology

"Editor Kyle Brauer Boone has assembled the 'best and the brightest' contributors to help current clinicians and researchers minimize the effects if sub-optimal effort or symptom exaggeration in their conduct of psychological and neuropsychological assessments....Forensic psychologists should find what they need to support testimony they provide and to refute testimony offered by someone who has not reviewed the material herein....This 'encyclopedia' is the type of reference that should be on the desk of every psychologist who conducts psychological assessments of any kind and is a must for all neuropsychologists who function in clinical and/or research settings. Each chapter provides the reader with the latest recommendations for assessing effort with clients requiring a determination of cognitive and/or emotional status. The psychologist interested in practical and precise assessment of clients in identified clinical groups will find answers in these chapters....The text is helpful to the researcher as well as the clinician because the data presented is current and relevant to both. Many topics are reviewed including attorney coaching, avoiding the death penalty, gaining entitlements, and how symptom validity tests may help in differential diagnosis."--Journal of Police and Criminal Psychology

"Some of the most prominent experts in the field contribute chapters that are comprehensive literature reviews on their respective topics....Clinicians and researchers in forensic psychology and neuropsychology will find this volume most valuable. It describes and advances technology for determining the validity of our assessments. The chapters inform the interested reader of applicable instruments, settings, and medical/psychological conditions....While the reader would certainly benefit from familiarity with the entire book, the collection can be viewed as a valuable and convenient reference guide for deciding which measures of malingering are appropriate in individual circumstances, specific disorders, particular demographics, and various levels of impairment....This book offers quantitative, actuarial decision formulas based on empirical evidence for assessing malingering....Will become a classic text that any forensic neuropsychologist must have on his or her shelf....We believe that this book has genuinely improved the scientific quality and diagnostic accuracy of our clinical assessments."--PsycCRITIQUES
Journal of the International Neuropsychological Society

"It is not possible to imagine a competent, ethical practitioner of forensic neuropsychology who should not read this book or one who would not routinely use it in day-to-day practice. Kyle Boone has amassed an impressive array of some of the most well respected scholar-clinicians in forensic neuropsychology in a volume that, as nearly as possible, provides cogent summaries of the burgeoning research literature in motivational assessment....Compelling in style and breadth...must be considered essential reading for forensic neuropsychologists, beginners, and journeymen alike. With the research literature so handily summarized, and recommendations for practical use that follow logically, it is likely that this will become a desk-side companion for practitioners. While many issues remain to be understood regarding effort and feigned illness, it is comforting to know that the state of the science is so well represented in this volume."--Journal of the International Neuropsychological Society
Cognitive Neuropsychiatry

"A timely and welcome addition to the field of symptom exaggeration and fabrication, an area that has been relatively neglected, traditionally fraught with methodological difficulties, and, until recently, limited by a lack of suitable evaluation measures....Boone takes on the task of bringing together historical, conceptual, and methodical aspects of cognitive effort assessment and the contributing authors provide useful guidance in the form of evidence-based practice recommendations....This comprehensive and up-to-date review provides a sound conceptual basis for the understanding of symptom invalidity and how it is best measured....One of its strengths lies in the practice recommendations made by the various contributors. Highly recommended."--Cognitive Neuropsychiatry
Doody's Review Service
Reviewer: Christopher J Graver, PhD, ABPP-CN(Madigan Healthcare System)
Description: The incidence of feigned cognitive impairment is much more rampant than was previously thought just a decade ago. Feigned cognitive impairment has dire implications in many arenas, including the legal system, school system, and even medical insurance and disability. This critical component of neuropsychological evaluations is the focus of the book.
Purpose: The purpose of this book is to present a host of symptom validity tests, summarize the literature on symptom validity testing, and provide empirically-supported recommendations for the use of these instruments in clinical and forensic examinations.
Audience: The book is aimed squarely at clinical neuropsychologists. The editor is an accomplished neuropsychologist and has made significant clinical and scholarly contributions to the field. The contributing authors are some of the most esteemed clinicians and researchers in this field.
Features: Although this book is filled with information about a multitude of symptom validity tests, it is well organized into relevant topics. An extensive section reviews the literature on many symptom validity tests organized by the type of instrument (e.g., forced-choice task, non forced-choice task, tasks embedded within other neuropsychological instruments). This is followed by chapters that target specific clinical problems, rather than the instruments themselves. These chapters range from symptom validity testing in criminal forensic evaluations to the impact of psychiatric disease on symptom validity to feigned mental retardation. The topics are covered in detail without compromising test security, which is commendable. Many of the chapters include relevant normative comparisons that are invaluable. The references are generally comprehensive and include studies as recent as 2006. The index is easy to use.
Assessment: This is an outstanding clinical reference that would benefit every neuropsychologist and student of neuropsychology. If one's goal is to be an informed, savvy evaluator of feigned cognitive impairment, there is no better resource on the market.
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Product Details

  • ISBN-13: 9781593854645
  • Publisher: Guilford Publications, Inc.
  • Publication date: 6/7/2007
  • Edition description: New Edition
  • Pages: 481
  • Product dimensions: 6.40 (w) x 9.30 (h) x 1.20 (d)

Meet the Author

Kyle Brauer Boone, PhD, ABPP, is Professor-in-Residence in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine, University of California, Los Angeles, and Director of Neuropsychological Services and Training in the Department of Psychiatry at Harbor-UCLA Medical Center in Torrance, California. She has published over 100 peer-reviewed articles in professional journals in the area of neuropsychological assessment and is a coauthor of Handbook of Normative Data for Neuropsychological Assessment. Dr. Boone has also published two tests used to assess for effort on neuropsychological exams: the b Test and the Dot Counting Test.

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Table of Contents

I. Symptom Fabrication: Social and Biological Perspectives

1. Feigning of Physical, Psychiatric, and Cognitive Symptoms: Examples from History, the Arts, and Animal Behavior, David C. Stone and Kyle Brauer Boone

2. Functional Neuroimaging of Deception and Malingering, Lisle R. Kingery and David J. Schretlen

II. Cognitive Effort Assessment Techniques and Strategies

3. A Reconsideration of the Slick et al. (1999) Criteria for Malingered Neurocognitive Dysfunction, Kyle Brauer Boone

4. Spoiled for Choice: Making Comparisons between Forced-Choice Effort Tests, Paul Green

5. Non-Forced-Choice Measures to Detect Noncredible Cognitive Performance, Stephen R. Nitch and David M. Glassmire

6. Intelligence Tests as Measures of Effort, Talin Babikian and Kyle Brauer Boone

7. Use of Standard Memory Tests to Detect Suspect Effort, Po H. Lu, Steven A. Rogers, and Kyle Brauer Boone

8. Validity Indicators within Executive Function Measures: Use and Limits in Detection of Malingering, Jerry J. Sweet and Nathaniel W. Nelson

9. Use of Motor and Sensory Tests as Measures of Effort, Ginger Arnold and Kyle Brauer Boone

10. The MMPI-2 Fake Bad Scale in Detection of Noncredible Brain Injury Claims, Manfred F. Greiffenstein, David Fox, and Paul R. Lees-Haley

III. Cognitive Effort Testing in Various Clinical Populations

11. Malingering Mild Traumatic Brain Injury: Behavioral Approaches Used by Both Malingering Actors and Probable Malingerers, John E. Meyers

12. Including Measures of Effort in Neuropsychological Assessment of Pain- and Fatigue-Related Medical Disorders: Clinical and Research Implications, Julie Suhr and Brad Spickard

13. The Impact of Psychiatric Disorders on Cognitive Symptom Validity Test Scores, Hope E. Goldberg, Carla Back-Madruga, and Kyle Brauer Boone

14. Identification of Feigned Mental Retardation, Tara L. Victor and Kyle Brauer Boone

15. Symptom Validity Tests in the Epilepsy Clinic, David J. Williamson, Daniel L. Drane, and Elizabeth S. Stroup

16. The Use of Effort Tests in the Context of Actual versus Feigned Attention-Deficit /Hyperactivity Disorder and Learning Disability, Kimberly Alfano and Kyle Brauer Boone

17. Cognitive Complaints in Multiple Chemical Sensitivity and Toxic Mold Syndrome, Robert J. McCaffrey and Christine L. Yantz

18. The Use of Effort Tests in Ethnic Minorities and in Non-English-Speaking and English as a Second Language Populations, Xavier F. Salazar, Po H. Lu, Johnny Wen, and Kyle Brauer Boone

19. Assessment of Malingering in Criminal Forensic Neuropsychological Settings, Robert L. Denney

20. Future Directions in Effort Assessment, Martin L. Rohling and Kyle Brauer Boone

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