One of the first patients August Price, M.A., saw at his practicum at the Boston VA was deemed a malingerer by an outside neuropsychologist because he’d failed validity testing. However, after Price conducted an extensive assessment, it turned out that the man actually had early-onset Alzheimer’s disease.
“This made me realize that the field could be doing better in screening for effort in geriatric populations,” said Price, a fifth-year clinical psychology student at William James College in Newton, Mass.
This experience inspired Price to focus his doctoral research on a more accurate way to measure malingering—by monitoring electrical activity in the brain.
Consequently, Price had 20 probable Alzheimer’s disease patients complete an attention-based task. He also had 20 older healthy participants perform the same attention-based task twice.
For the first time, participants were told to perform honestly. For the second time, they were told to pretend they had dementia. Price handed participants a symptom checklist he pulled from Google. He didn’t provide any other instructions, so this would be a “realistic interpretation of how someone might pretend or simulate dementia,” Price said.
Findings revealed that the healthy participants produced almost identical electrical potentials during both testing sessions. “In essence, they were unable to fake or manipulate their brain wave activity,” Price said.
This research may have broader implications. According to an article in the Journal of Clinical and Experimental Neuropsychology, “Malingered symptoms have been of increasing concern in neuropsychological assessment because most cognitive tests require optimal effort from the evaluee in order to achieve results that accurately reflect brain functioning.”
In other words, as Price said, having an accurate measure of validity is vital because it provides “diagnostic clarity.” It “adds to the ability to diagnose and give accurate, effective recommendations for treatment.”
As Price’s practicum experience illustrates, many individuals don’t intend to be deceptive. In fact, according to Price’s advisor, Jason Osher, Ph.D, associate professor at William James College, there are many reasons why someone’s performance may be compromised.
For example, he said, individuals might be struggling with severe anxiety. During the assessment, “their thoughts are being taken up by all the things that are making them anxious. Their attention is divided, and there’s no way they can devote the same amount of effort.”
Price noted that research also has found that severe depression can hinder performance, because individuals are, understandably, unable to focus long enough to take the demanding cognitive tests.
Osher said, “Low performance might not mean a cognitive deficit; it might be an intense mood disorder.”
Having an accurate measure of malingering also is critical in situations where individuals are being deceptive—particularly when money is a significant incentive. For example, individuals may fake the severity of their symptoms to gain greater disability benefits or compensation from a car accident.
Price is planning to extend his research to individuals with a traumatic brain injury (TBI). Recently, he read that “40 percent of TBI patients are flagged for suboptimal testing.”
“TBI is a broad and heterogeneous group,” Osher said. Two individuals with similar injuries can be impacted in very different ways, he said, making it difficult to understand what’s really going on with a person.
In short, “It’s messy. Any clarity we can get would be really helpful.”
Price noted, “The developments made in neuroscience are really tremendous,” and he encourages psychologists to “embrace the new technology we have at our disposal.”
Margarita Tartakovsky, MS, is a Florida-based freelance writer and an associate editor at PsychCentral.com.