Masquerades of Brain Injury. Part III: Critical Examination of Symptom Validity Testing and Diagnostic Realities in Assessment.

BACK

The Journal of Controversial Medical Claims, 9, 2, 19-21.

Especially in medicolegal evaluations, assessment of response bias is critical to ensuring accurate determination of symptom source or diagnosis and thereby appropriate decisions on treatment and compensation, and the prevention of iatrogenic complications. Unfortunately, the recent increase in attention to response bias assessment has too often been accompanied by overzealous application of poorly validated detection procedures and questionably strong opinions regarding malingering. Although these instruments and procedures vary in terms of empirical support, all have identifiable limitations. This paper reviews these limitations, concludes that response bias detection methodology is still developing. The review of shortcomings underscores the need for caution in interpretation, the importance of integrating multiple data sources, including behavioral observations, interview data, test results, medical workups, historical and collateral sources of information, as well as specific measures of effort and response bias, a motivational assessment model that conceptualizes effort on a continuum and is dependent on multiple strategies and measures that are not easily conveyed, and the need for further research.

http://www.angelfire.com/va/MFMartelliPhD/Masq_FDO.pdf