Abstract
The present paper offers resource material for evaluation of malingering, response bias, and symptom and performance validity. The material mostly consists of noncontroversial, paraphrased excerpts from relevant consensus statements, guidelines, codes, books, and articles. The five principles of the American Psychological Association (APA) ethics code were used to integrate the material. In addition, five other principles were needed (e.g., on science). The companion article on a new consensus statement on the ethical use of symptom and performance validity written for the Association for Psychological Advancement in Psychological Injury and Law (ASAPIL) in the journal Psychological Injury and Law (PIL; Bush, Ruff, & Heibronner, 2014) was instigated by and written partly based on the resources described in the present paper. The resources offered in the present paper are divided into the following sections: I. Malingering; II. Related Terms; III. APA Ethics Code; IV. Other Ethics Guidelines; V. Practice Guidelines; VI. Assessment Guidelines; VII. Other Ethical Sources; IX. Biases, Fallacies, Errors; X. Prior SVT-M/PVT-M Statements; XI. A New Ethical Model of Ten Principles; and XII. Instrumentation, and followed by Conclusions. The ten principles of the present ethical guidelines could be used to help revise the APA ethics code. The companion statement constitutes a major advance in the field and the present resource material facilitates its use.
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This resource paper provides supplementary material (Appendix) to consider for the companion consensus statement in symptom and performance validity assessment in forensic and related civil disability determinations (Psychological assessment of symptom and performance validity, response bias, and malingering: Official position of the Association for Psychological Advancement in Psychological Injury and Law, Bush, Ruff, & Heilbronner, Psychological Injury and Law, 7 (3), 2014).
The resource includes summaries of the prior consensus statements on the assessment of symptom and performance validity in neuropsychological assessments (Bush et al., 2005; Heilbronner, Sweet, Morgan, Larrabee, Millis, & Conference Participants, 2009). The present consensus statement was built on the basis of the prior ones, but was structured on ethical principles, especially as described in the APA ethics code (American Psychological Association, 2010). Therefore, the resource material in this supplement includes the APA code’s five principles.
I used the five principles in the APA ethics code as a starting point to cover a lot of the resource material in the present work. However, more principles were needed to include all the material in the resources—e.g., on the APA code (2010), the forensic specialty guidelines (APA, 2013), FMHA foundations (Forensic Mental Health Assessment; Heilbrun, Grisso, & Goldstein, 2009), various works on ethics in the 2012 APA Ethics handbook (e.g., Gottlieb & Coleman, 2012), and my own malingering book (Young, 2014a). Therefore, I found it necessary to create five more ethical principles, for example, on science and ethics. That is, toward constructing the new consensus statement, I found it necessary to elaborate on the five basic ethical principles in the APA code, and constructed five new ones for the task. The result is a 10-principle code. Together, the ten principles not only help structure the appropriate use of symptom validity tests and measures (SVTs/SVMs)/performance validity tests and measures (PVTs/PVMs) in work in the area of psychological injury and law but also how to understand ethics globally. That is, they could serve as a basis for future revisions of the APA ethics code.
Other notable components of the present supplement on ethical use of SVMs/PVMs include (a) extensive tables of excerpts from pertinent practice guidelines and articles that are paraphrased for the present purposes, (b) an extensive listing of relevant definitions, and (c) listing of the basic tests and measures that can be used in the area (nonexhaustive, does not imply recommendation). About the tests and measures in the area, although SVMs/PVMs are used in cognitive and emotional/psychopathology evaluations, the assessment instruments include several other types in these regards: (a) interview schedules (Miller Forensic Assessment of Symptoms Test (M-FAST), Miller, 2001; Structured Interview of Reported Symptoms (SIRS), Rogers, Bagby, and Dickens (1992); Structured Interview of Reported Symptoms, Second Edition (SIRS-2), Rogers, Sewell, & Gillard, 2010): (b) F family type scales on personality inventories (Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2), Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989; Butcher, Graham, Ben-Porath, Tellegen, Dahlstrom, & Kaemmer, 2001; Minnesota Multiphasic Personality Inventory, Second Edition Restructured Form (MMPI-2-RF), Ben-Porath & Tellegen, 2008/2011; Personality Assessment Inventory (PAI), Morey, 1991, 2007); (c) embedded neuropsychological tests (e.g., Reliable Digit Span (RDS), Greiffenstein, Baker, & Gola, 1994); (d) scales in dedicated tests, such as the TSI-2 (Trauma Symptom Inventory, Second Edition; Briere, 2011) for posttraumatic stress disorder (PTSD); as well as the (e) stand-alone forced-choice tests (e.g., Test of Memory Malingering (TOMM), Tombaugh, 1996; Victoria Symptom Validity Test (VSVT), Slick, Hopp, Strauss, & Thompson, 1997/2005).
The companion consensus statement emphasizes (a) the need for ethical practice in assessing evaluee validity and using SVMs/PVMs in forensic and related disability assessments, (b) consideration of factors such as culture and gender in these regards, and (c) adopting a comprehensive, unbiased, and scientific approach to assessment (testing, reasoning) when working in the area of psychological injury and law. The resources provided are noncontroversial and, along with the consensus statement, can help guide research on the assessment of validity in the forensic disability evaluation and related context.
The resources offered in the present paper are divided into the following sections: I. Malingering; II. Related Terms; III. APA Ethics Code; IV. Other Ethics Guidelines; V. Practice Guidelines; VI. Assessment Guidelines; VII. Other Ethical Sources; IX. Biases, Fallacies, Errors; X. Prior SVT-M/PVT-M Statements; XI. A New Ethical Model of Ten Principles; and XII. Instrumentation, and followed by Conclusions.
Malingering
The first table of resource material on the evaluation of malingering and related response styles concerns various definitions of malingering (see Table 1). The Diagnostic and Statistical Manual of Mental Disorders (DSM) (DSM-IV-TR; DSM-5; American Psychiatric Association, 2000, 2013, respectively) definition is considered the standard one in the field, and its definitions combine gross exaggeration with the production of feigned symptoms. Note that Table 2 shows that in the DSM-5 there are some “minor” changes to the definition of malingering relative to the one in the DSM-IV-TR. However, some of the changes made in the definition of malingering in the new addition of the DSM include ones that might not be minor in that they appear to lower somewhat the bar for its attribution. That said, excluding the term of malingering from the subject index of a psychiatric nosological manual, as has happened in the DSM-5 manual, seems to raise it out of existence!
Note that, unlike the case for the DSM, other approaches to defining malingering do not include exaggeration in their definitions. Part of the difficulties encountered in the field relate to an absence of an unambiguous definition of the term of malingering. Table 1 presents an integrated approach in defining malingering.
Given the difficulties in clearly defining malingering, it is not surprising that estimates of its base rate or prevalence vary (see Table 3). The estimates range from below 10 % (even 1 %) to over 50 %. More likely, problematic presentations and performances, in general, express the latter range, with the percentage of outright malingering in the former range (as reviewed in Young, 2014a).
Related Terms
Tables 4, 5, 6, 7, 8, and 9 present multiple terms related to malingering, but ones that do not include the intention to deceive for financial gain or other external incentives, as found in malingering. Evaluators who obtain evaluation data indicative of a general feigning, or otherwise noncredible presentation end performance, but without compelling, irrefutable evidence for malingering, should use terminology in their conclusions other than malingering to implicate in their evaluees a less than frank approach to the assessment.
Other Ethics to Guidelines
Tables 12, 13, and 14 are based on the common standards for psychological testing and assessment (American Educational Research Association, American Psychological Association, & National Council on Measurement in Education, 1999, 2014). The tables concern diagnosis, interpretation, and responsibilities, respectively. The major change in the 2014 revision relative to the earlier 1999 version is that it includes a statement on the need to check for evaluee effort, which is consistent with the present approach.
Practice Guidelines
Tables 15, 16, 17, and 18 present forensic guidelines relevant to the source material collected in the current paper. They derive from the American Psychological Association’s (2013) forensic practice guidelines. The tables are on responsibilities, science, methods/procedures, and assessment, respectively.
Other Ethical Sources
Next, the present resource material considers another APA guideline, this time on disability (APA 2012; see Table 25). Then, it gives a relevant table based on the AAPL guidelines (American Academy of Psychiatry and the Law 2005; see Table 26).
The next set of tables and a figure (see Tables 27, 28, and 29; Fig. 1) are meant to help in ethical practice. The tables are derived from Pope and Vasquez (2011), Gottlieb and Coleman (2012) and Bush et al. (2012). The figure is taken from Young (2014a).
Biases, Fallacies, Errors
Tables 30, 31, 32, 33, 34, 35, and 36 involve material on biases, fallacies, and errors taken from diverse sources. The forensic evaluator and others conducting disability determinations should examine carefully these sources as much as the others. Table 36 summarizes a review of the definition of bias and its major classes that might be found in forensic mental health evaluations (Neal & Grisso, 2014). The reader is referred to the solutions offered by the authors in the article, which are only briefly summarized here.
Prior SVT/PVT Statements
Tables 37, 38, 39, and 40 present excerpts from the extant consensus statements on use of SVT-Ms/PVT-Ms in forensic practice (Bush et al., 2005; Heilbronner et al., 2009), as well as from Iverson (2006). These sources are the primary ones to consider aside from the companion paper on the ASAPIL consensus statement on the topic (Bush et al., 2014).
A New Ethical Model of Ten Principles
The resource materials given in the present paper were integrated into a coherent ethical structure (see Tables 41, 42, and 43). The first one frames them within a model of adult reasoning (Young, 2011). The following one presents the integrated material that fit the five principles of the current APA ethics code. The last table presents the integrated material within five new principles especially created for the present exercise. The consensus statement prepared for ASAPIL in Bush et al. (2014) considered this new formulation of ethical principles.
Instrumentation
The remaining tables present many of the psychological tests and scales that can be used to provide psychometrically sound data in forensic disability and related determinations. There are five classes of such instruments: (a) stand-alone two-choice forced alternative tests (see Table 44); (b) embedded cognitive/neuropsychological tests/scales (see Table 45); (c) dedicated scales (e.g., for pain, PTSD; see Tables 46 and 47); (d) interview schedules (see Table 48); and (e) personality omnibus inventories (see Table 49). This listing is not meant to be exhaustive, nor does it constitute a recommendation. Rather, for each assessment undertaken in this area of practice, the evaluator is responsible for selecting the tests and scales that have the best scientific support and fit for the referral question at hand, and that are appropriate for the evaluee being assessed, including consideration of special characteristics, such as gender, age, culture, minority status, language, disability status, and so on.
Conclusion
This resource material on the ethical use of SVT-Ms/PVT-Ms in forensic disability and related assessments is meant to help in any assessment involving psychological injury. Prior consensus statements (Bush et al., 2005; Heilbronner et al., 2009) focused on the cognitive/neuropsychological domain (e.g., for cases of mild traumatic brain injury, mTBI). The aim of the present paper and its companion consensus statement is to supply resource material and standards for appropriate aspirational goals in testing and measurement of malingering and negative response bias that could guide effectively assessors in the area for assessment of any type of psychological injury, including mTBI, PTSD, and chronic pain.
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Young, G. Resource Material for Ethical Psychological Assessment of Symptom and Performance Validity, Including Malingering. Psychol. Inj. and Law 7, 206–235 (2014). https://doi.org/10.1007/s12207-014-9202-2
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DOI: https://doi.org/10.1007/s12207-014-9202-2