The Efficiency and Accuracy of The Test of Memory Malingering Trial 1, Errors on the First 10 Items of The Test of Memory Malingering, and Five Embedded Measures in Predicting Invalid Test Performance

Archives of Clinical Neuropsychology 27 (2012) 417–432 The Efficiency and Accuracy of The Test of Memory Malingering Trial 1, Errors on the First 10 Items of The Test of Memory Malingering, and Five Embedded Measures in Predicting Invalid Test Performance Mental Health Care Line, Department of Psychology, Tennessee Valley Healthcare System, Alvin C. York Veterans Affairs Hospital, Murfreesboro, TN, USA *Corresponding author at: Mental Health Care Line, Department of Psychology, Tennessee Valley Healthcare System, Alvin C. York Veterans Affairs Hospital, Murfreesboro, TN 37129, USA. Tel.: +1-615-225-3923; fax: +1-615-225-6361. E-mail address: (J.H. Denning). Accepted 29 March 2012 Abstract The current study attempted to improve upon the efficiency and accuracy of one of the most frequently administered measures of test validity, the Test of Memory Malingering (TOMM) by utilizing two short forms (TOMM trial 1 or TOMM1; and errors on the first 10 items of TOMM1 or TOMMe10). In addition, we cross-validated the accuracy of five embedded measures frequently used in malingering research. TOMM1 and TOMMe10 were highly accurate in predicting test validity (area under the curve [AUC] ¼ 92% and 87%, respectively; TOMM1 ≤40 and TOMMe10 ≥1; sensitivities .70% and specificities .90%). A logistic regression of five embedded measures showed better accuracy compared with any individual embedded measure alone or in combination (AUC ¼ 87%). TOMM1 and TOMMe10 provide evidence of greater sensitivity to invalid test performance compared with the standard TOMM administration and the use of regression improved the accuracy of the five embedded cognitive measures. Keywords: Test of Memory Malingering; Medical Symptom Validity Test; symptom validity testing; Malingering; Veterans; Neuropsychology Introduction Over the past two decades, there has been an increased interest in the assessment of test validity/malingering in neuropsychological assessment. There are now comprehensive reviews and assessment compilations available to the neuropsychologist regarding the assessment of test validity and malingering (Boone, 2007; Larrabee, 2007) as well as consensus statements from neuropsychological organizations clearly articulating the importance of validity assessment in clinical, research, and forensic settings (ABCN, 2007; Bush et al., 2005; Heilbronner et al., 2009). Despite the variety of tests developed to assess for invalid test performance, there is a constant need to update and refine these measures as patients become more aware of these methods and, therefore, putting at risk the validity of these valuable assessment techniques (Bauer & McCaffery, 2006; Kaufmann, 2009; Morel, 2009). Both freestanding and embedded measures of effort have been utilized across a variety of settings (Sharland & Gfeller, 2007). A robust relationship reflecting lower cognitive performance across neuropsychological tests has been repeatedly found in those failing validity measures (Constantinou, Bauer, Ashendorf, Fisher, & McCaffrey, 2005; Gervais, Rohling, Green, & Ford, 2004; Green, 2006; Green, Rohling, Lees-Haley, & Allen, 2001; Gunner, Miele, Lynch, & McCaffrey, 2012; Locke, Smigielski, Powell, & Stevens, 2008; Marshall et al., 2010; Meyers, Volbrecht, Axelrod, & Reinsch-Boothby, 2011; Schiehser et al., 2011; Suhr, Hammers, Dobbins-Buckland, Zimak, & Hughes, 2008). The expected relationship between the severity of brain injury pathology and neurocognitive measures is often confounded/reduced when validity measures are failed (Fox, 2011). One drawback of many freestanding measures is that administration time is often long, and the end result is often a “yes” or “no” finding regarding the validity of performance on that particular task. Increasing the Published by Oxford University Press on behalf of US Government 2012. doi:10.1093/arclin/acs044 John H. Denning* 418 J.H. Denning / Archives of Clinical Neuropsychology 27 (2012) 417–432 Table 1. TOMM trial 1 cut scores reflecting 100% specificity for passing the TOMM Study (first author) N Sample TOMM trial 1 cut score Armistead-Jehle (2011) 75 Active duty military (clinical) Ashendorf (2004) Bauer (2007) Brooks (2012) 197 105 53 Non-clinical elderly (Anx/Depx) mTBI litigants Pediatric neurology patients Etherton (2005) Gavett (2005) Gierok (2005) Hilsabeck (2011) Iverson (2007) Kirk (2011) Morgan (2009) Musso (2011) 20 20 77 20 229 54 101 14 54 Student controls Acute pain controls mTBI litigants Psychiatric inpatients Mixed clinical Fibromyalgia with depression/pain Pediatric clinical patients Litigantsb Student controls O’Bryant (2008) 306 Non-clinical elderly 89 Mixed clinical Rees (2001) Ryan (2010) Teichner (2004) Tombaugh (1996) 26 72 21 142 Depressed inpatients Student controls Clinical-elderly normal Mixed clinicalc Vanderslice-Barr (2011) Yanez (2006) 96 20 Student controls Controls ≥32a ≥45 ≥40a ≥44a ≥36a ≥45 ≥45a ≥45 ≥45 ≥36a ≥41 ≥40a ≥33a ≥39a ≥39a ≥45 ≥40a ≥45 ≥41a ≥45 ≥45 ≥42a ≥40a ≥41a ≥45 ≥40a ≥45 Notes: TOMM ¼ Test of Memory Malingering; mTBI ¼ mild traumatic brain injury; Anx ¼ anxiety, Depx ¼ depression. a Denotes inclusion of the entire sample. b Selected case series. c TOMM administration manual (1996). administration efficiency of freestanding measures (while at the same time maintaining high sensitivity to non-credible performance) would be highly valued given the often time-limited nature of many neuropsychological evaluations. In order to assess test validity more efficiently, we will attempt to improve upon the Test of Memory Malingering (TOMM; Tombaugh, 1996) which is already one of the most commonly administered freestanding measures of cognitive test validity (Sharland & Gfeller, 2007). The TOMM has an extensive research base identifying those exaggerating cognitive deficits (Boone, 2007; Larrabee, 2007; Sollman & Berry, 2011; Tombaugh, 1996) with very low false-positive rates in many clinical populations (Greve, Bianchini, Black, et al., 2006; Greve, Ord, Curtis, Bianchini, & Brennan, 2008; Haber & Fichtenberg, 2006; Iverson, Le Page, Koehler, Shojania, & Badii, 2007; Tombaugh, 1996). A recent meta-analytic review of the TOMM by Sollman and Berry (2011) found good accuracy statistics across a range of settings and populations (sensitivity ¼ 65%, specificity ¼ 94%, overall hit rate ¼ 80%). Because the TOMM is often perceived as very easy or not likely measuring cognitive ability (Tan, Slick, Strauss, & Hultsch, 2002), it may not be as sensitive to poor effort compared with other freestanding measures (Armistead-Jehle & Gervais, 2011; Bauer, O’Bryant, Lynch, McCaffrey, & Fisher, 2007; Gervais, Rohling, Green, & Ford, 2004; Green, 2007, 2011). Greiffenstein and colleagues (2008) proposed that incorporating all three trials of the TOMM in decision-making (utilizing a cutoff of ,45 on Trial 1, Trial 2 or retention trials) provides equivalent concordance rates with the Word Memory Test (WMT, Green, 200 (...truncated)