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Chapter 20

PSYC31H3 Chapter Notes - Chapter 20: Response Bias, Neuropsychological Test, Malingering

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Konstantine Zakzanis

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Chapter 20 Testing for Effort, Response Bias, and Malingering
-accurate interpretation and conclusions about neuropsychological test data are necessarily premised
on the assumption that the data are valid
-essential for drawing conclusions, rending diagnoses, and making treatment recommendations
-compromised validity is more likely when an evaluation involves the possibility of secondary gain
-emotional reactions to new limitations occasioned by injury or disease, or due to the primary effects of
neurologic condition itself can bring about additional symptoms or exacerbate existing ones
-traditionally determination of whether the neuropsychological findings are valid usually rested on:
-evidence of consistency in the history or examination
-the likelihood that the set of symptoms and neuropsychological test profile makes medical
-an understanding of the patient’s present situation, personal/social history, and emotional
-emotional reactions to their symptoms and complaints, such as patients who smile while
relating a medical history rife with physical ailments and doctor visits
-the increased involvement of neuropsychologists in forensic evaluations of all kinds has sharpened the
focus on symptom validity and malingering issues
-on the other hand the problem of effort, response bias, and malingering is further complicated by
patients with real neuropsychological deficits, that “fake good” to maintain dignity and appear
-generally it is harder to “fake good” than to “fake bad” on cognitive performance-based measures
-near impossible to function above ones true ability without substantial practice
-motivation to perform poorly may simply be due to the desire to receive attention as a patient or to
play the sick role
-the DSM suggests that malingering should be strongly suspected whenever diagnosis involves a
medicolegal issue
-to avoid prediction error, giving only one test of effort or bias should be avoided
-also varying the time frame when test of effort and malingering can be extremely useful
-some patients with neurologically based deficits may intentionally perform poorly on
neuropsychological testing to exaggerate their symptoms
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