Malingering on the Social Security Disability Consultative Exam: Predictors and Base Rates

The Disability Determinations Service (DDS) obtains evidence about an applicant from sources that may include the Psychological Consultative Examination (PCE), which usually includes a mental status examination and Wechsler Scale findings. Although evidence for good effort is necessary to validate the findings, psychologists have been officially discouraged from determining effort by the use of formal tests. In Chafetz, Abrahams, and Kohlmaier (2007 Chafetz , M. D. , Abrahams , J. P. , & Kohlmaier , J. ( 2007 ). Malingering on the Social Security Disability consultative exam: A new rating scale . Archives of Clinical Neuropsychology , 22 , 1 – 14 .[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]), indicators of effort within the PCE in WAIS-age (adults) and WISC-age (children) claimants were determined, and a PCE Malingering Rating Scale was developed. In the present study, this new scale was used along with established symptom validity tests (SVTs) to determine base rates and additional predictors of malingering within the PCE. Claimants were apportioned into separate effort groups in a “dose–response” manner: Definite Malingerers, Chance-Level, Fail Both (SVT and Rating Scale), Fail One, Fail Indicators, and Not Fail. Data from separate studies using the Test of Memory Malingering (TOMM), and the Medical Symptom Validity Test (MSVT) were used to assign claimants into separate effort groups. An evidence-based assessment approach utilized these base-rates to calculate post-test odds. Other predictors of effort within the PCE include the presence of conduct disorder symptoms, and the number of other family members on Disability.     

Symptom validity issues in the psychological consultative examination for social security disability

This article is about Social Security Administration (SSA) policy with regard to the Psychological Consultative Examination (PCE) for Social Security Disability, particularly with respect to validation of the responses and findings. First, the nature of the consultation and the importance of understanding the boundaries and ethics of the psychologist's role are described. Issues particular to working with low-functioning claimants usually form a large part of these examinations. The psychologist must understand various forms of non-credible behavior during the PCE, and how malingering might be considered among other non-credible presentations. Issues pertaining to symptom validity testing in low-functioning claimants are further explored. SSA policy with respect to symptom validity testing is carefully examined, with an attempt to answer specific concerns and show how psychological science can be of assistance, particularly with evidence-based practice. Additionally, the nature and importance of techniques to avoid the mislabeling of claimants as malingerers are examined. SSA requires the use of accepted diagnostic techniques with which to establish impairment, and this article describes the implementation of that requirement, particularly with respect to validating the findings.      

Determination of the smoking gun of intent: significance testing of forced choice results in social security claimants

Objective: Significantly below-chance findings on forced choice tests have been described as revealing “the smoking gun of intent” that proved malingering. The issues of probability levels, one-tailed vs. two-tailed tests, and the combining of PVT scores on significantly below-chance findings were addressed in a previous study, with a recommendation of a probability level of .20 to test the significance of below-chance results. The purpose of the present study was to determine the rate of below-chance findings in a Social Security Disability claimant sample using the previous recommendations. Method: We compared the frequency of below-chance results on forced choice performance validity tests (PVTs) at two levels of significance, .05 and .20, and when using significance testing on individual subtests of the PVTs compared with total scores in claimants for Social Security Disability in order to determine the rate of the expected increase. Results: The frequency of significant results increased with the higher level of significance for each subtest of the PVT and when combining individual test sections to increase the number of test items, with up to 20% of claimants showing significantly below-chance results at the higher p-value. Conclusions: These findings are discussed in light of Social Security Administration policy, showing an impact on policy issues concerning child abuse and neglect, and the importance of using these techniques in evaluations for Social Security Disability.     

Official Position of the American Academy of Clinical Neuropsychology Social Security Administration Policy on Validity Testing: Guidance and Recommendations for Change

The milestone publication by Slick, Sherman, and Iverson (1999) of criteria for determining malingered neurocognitive dysfunction led to extensive research on validity testing. Position statements by the National Academy of Neuropsychology and the American Academy of Clinical Neuropsychology (AACN) recommended routine validity testing in neuropsychological evaluations. Despite this widespread scientific and professional support, the Social Security Administration (SSA) continued to discourage validity testing, a stance that led to a congressional initiative for SSA to reevaluate their position. In response, SSA commissioned the Institute of Medicine (IOM) to evaluate the science concerning the validation of psychological testing. The IOM concluded that validity assessment was necessary in psychological and neuropsychological examinations (IOM, 2015 Institute of Medicine. (2015). Psychological testing in the service of disability determination. Washington, DC: Institute of Medicine. Retrieved from http://iom.nationalacademies.org/Reports/2015/PsychTesting.aspx [Google Scholar]). Objective: The AACN sought to provide independent expert guidance and recommendations concerning the use of validity testing in disability determinations. Method: A panel of contributors to the science of validity testing and its application to the disability process was charged with describing why the disability process for SSA needs improvement, and indicating the necessity for validity testing in disability exams. Results: This work showed how the determination of malingering is a probability proposition, described how different types of validity tests are appropriate, provided evidence concerning non-credible findings in children and low-functioning individuals, and discussed the appropriate evaluation of pain disorders typically seen outside of mental consultations. Conclusions: A scientific plan for validity assessment that additionally protects test security is needed in disability determinations and in research on classification accuracy of disability decisions.     

Social Facilitation Effect of Examiner Attention or Inattention to Computer-Administered Neuropsychological Tests: First Sign that the Examiner May Affect Results

Studies have demonstrated that third-party observation impairs performance on some types of neuropsychological tests. The current study was designed to determine if the examiner's attention or inattention during computerized tests would have similar effects on performance as third-party presence or absence. This study examined the effects of the test administrator's attention or inattention on the performance of 74 undergraduates on computerized versions of the Word Memory Test, the Test of Memory Malingering (TOMM), and the Wisconsin Card Sorting Test. The results from independent samples t-tests showed that there were significantly more total errors on the TOMM in the unobserved group than the observed group. This is the first indication that computerized symptom validity tests may be affected by examiner's attention to the examinee's performance.     

Accuracy of the Modified Somatic Perception Questionnaire and Pain Disability Index in the Detection of Malingered Pain-Related Disability in Chronic Pain

The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. Patients were grouped based on independent psychometric evidence of MPRD. Results showed that MSPQ and PDI scores were not associated with objective medical pathology. However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.     

Measuring disability in patients with chronic fatigue syndrome: reliability and validity of the Work and Social Adjustment Scale

Background

Disability is a defining feature of chronic conditions, and it is an increasingly used measure of therapy effectiveness. The Work and Social Adjustment Scale (WSAS) is a simple and clear measure of disability. Although the scale is widely used, no study has yet investigated its psychometric properties in patients with chronic fatigue syndrome (CFS).

Methods

Data from two samples of patients were used, one from a multicenter randomized controlled clinical trial of treatments for CFS (n =639) and the other from a clinic that specializes in CFS (n=384). All patients completed the WSAS as well as other measures.

Results

Internal consistency and the Spearman-Brown split-half coefficient values indicated that the scale is reliable. CFS patients who had comorbid diagnoses of depression, anxiety or fibromyalgia had higher WSAS scores. High levels of disability were associated with high number of physical symptoms, severe fatigue, depression, anxiety, poor sleep quality and poor physical fitness, with correlation coefficients ranging between 0.41 and 0.11. Lower scores on the WSAS were modestly associated with better physical functioning as well as higher levels of physical capacity as assessed by a walking test. Sensitivity to change was evaluated in a subgroup of patients who had undergone a course of cognitive behavioral therapy. Disability significantly decreased after therapy and remained stable at follow-ups.

Conclusion

The WSAS is a reliable and valid assessment tool for disability in patients with CFS.     

The Role of Event-Related Rumination and Perceived Social Support on Psychological Distress during the COVID-19 Pandemic: Results from Greater Daegu Region in South Korea

ObjectiveResearch on psychological distress from the coronavirus disease 2019 (COVID-19) crisis has increased significantly, but the factors that can exacerbate or mitigate such distress have remained underexplored. To address the research gap, this study examined whether two types of rumination and perceived social support predict psychological distress during the pandemic. MethodsParticipants were recruited from communities of the greater Daegu area (n=316) where the first massive outbreak in South Korea occurred and most residents underwent substantial disruption of daily life. They completed self-report questionnaires that included measures of psychological distress, event-related rumination, and social support. ResultsThe hierarchical regression analysis showed that maladaptive intrusive rumination and perceived social support predicted increases and decreases in psychological distress, respectively, even when subjective severity of COVID-19-related experiences was controlled. Putatively adaptive type of rumination (i.e., deliberate rumination) was not a significant predictor concurrently. ConclusionThis is among the early endeavors to comprehensively understand risk and protective factors associated with an effective coping strategy against the COVID-19 crisis. Our results indicate that intrusive rumination aggravates but social support mitigates psychological distress during the pandemic, indicating that we can better adapt by differently attending to recent experiences and maintaining perceived social support.     

Therapeutic effects of the selective serotonin noradrenaline reuptake inhibitor milnacipran on depressive symptoms in patients with Alzheimer's disease

To clarify the profile of depressive symptoms in major depressive episodes in patients with Alzheimer's disease (AD-MD), we compared AD-MD with major depressive disorder in non-demented elderly patients (MDD) matched for age, using the 17-item Hamilton Rating Scale for Depression (HAM-D₁₇). In addition, to clarify which depressive symptoms of AD patients respond to treatment with the selective serotonin and noradrenaline reuptake inhibitor (SNRI) milnacipran, we compared the HAM-D₁₇ average score and the score of each HAM-D item, the mini-mental state examination (MMSE) score, and GAF score according to the DSM-IV evaluation of AD-MD patients at baseline and at the endpoint (12 weeks).