Feigning neuropsychological impairment: A critical review of methodological and clinical considerations

Abstract Despite a burgeoning literature on malingering, clinicians have few assessment tools for the accurate classification of those persons feigning cognitive and neuropsychological deficits. We examine problems inherent in the validation of these assessment measures. We identify and discuss six potential strategies for the detection of feigned neuropsychological deficits: (a) floor effect, (b) symptom validity testing (SVT), (c) performance curve, (d) magnitude of error, (e) atypical presentation, and (f) psychological sequelae. In light of the available research, we critically review specific methods which incorporate these strategies. We found that Rey's 15-Item Memory Test, as a measure of floor effect, had very low sensitivity rates. We also found considerable variability in SVT methods; a computerized version of SVT (Pritchard & Moses, 1991) that measured auditory, visual, and memory abilities had a satisfactory sensitivity of 67%. Overall, strategies that employed performance curves appeared to have the greatest promise in identifying potential malingerers. The remaining three detection strategies have not been adequately tested .