A claimant reports memory loss following
a head injury, and you need to determine
the objective degree of impairment.

Disability and liability claims of this nature are extremely difficult to evaluate. With thousands or even millions of settlement or benefit dollars often at stake, both insurers and claimants need reliable clinical information which can objectively corroborate the severity and scope of cognitive impairment.

A comprehensive neuropsychological evaluation
which employs a dissimulation testing strategy.

Over the years specialized neuropsychological tests have been validated in clinical trials (i.e., standardized), and are successfully employed today to assess short and long-term memory, intellectual capacity, attention span and concentration, language comprehension, hand-eye coordination, visual-spatial status, and other key areas of cognition.

When competently and appropriately administered, NT meticulously documents the degree and scope of cognitive impairment, and can even pinpoint affected areas of the brain. In head injury cases involving suspected malingering or fraud, the process can readily detect subtle and gross patterns of symptom exaggeration and faking.

How a dissimulation testing strategy works
NT detects evidence of symptom exaggeration by employing a "dissimulation strategy" that tests the same areas of cognitive functioning in ways which appear unrelated to the examinee. Individuals who exaggerate or fake symptoms tend to perform inconsistently on such tests, with a clear pattern of deception often emerging.

Can these tests and the professionals administering them be "fooled"? While an individual so inclined can deliberately perform poorly on any given test, the greater the number and variety of tests administered, the more difficult it becomes to consistently perform poorly in the same areas of cognition. Assuming a full days worth of comprehensive testing is performed, it is very unlikely that deliberate attempts to feign or exaggerate symptoms would go undocumented.

Utilizing the CARB and WMT Tests
Two recently developed tests, the CARB (Computerized Assessment of Response Bias) and the WMT (Word Memory Test) are now available which more specifically address issues of motivation and effort, and tendencies to exaggerate or feign symptoms. CARB has been extensively normed (validated) and can be self-administered on almost any IBM-compatible in less than a half hour. The CARB is also available in a Spanish version.

The WMT is a dual-purposed test which assesses both malingering and memory using a single, paired associates word list. The WMT has been validated in 218 compensation cases and can be administered orally or by computer in about 15 minutes. The WMT measures both effort and performance. The CARB and WMT can be employed along with other neuropsychological and psychological tests to maximize the potential for detecting and corroborating symptom exaggeration and/or malingering.

Malingering Test Batteries: Are they biased?
Are tests like the CARB and WMT unfair or biased attempts to attack the credibility of the genuinely and profoudly impaired? Based on my own experience and understanding of the process, I've found just the opposite to be true. By its very nature, a dissimulation testing strategy can also corroborate the accuracy of patient self-reporting, and help validate the severity and scope of existing cognitive impairment. Far from being "anti-claimant" or antagonistic to the interests of victims of accidents or medical malpractice, reliable and verifiable testing methods can only serve to protect the interests of all concerned parties.

If you'd like more information on neuropsychological testing and documenting malingering, see our special on-line guide, The ABCs of Managing Psychiatric Disability Cases. Or, pick up your phone and call us toll free at (888) 779-2524.

Sincerely,

Leonard Grossman Ph.D.,
President, The Forest Hills IPA Inc.
Diplomate, The American Board of Forensic Examiners

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