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Abstract
This article reports six cases of litigants claiming neuropsychiatric impairment due to toxic mold exposure. In spite of recent growth in personal injury claims due to mold, numerous reviews of the literature have failed to find an association between environmental exposure to mold and neuropsychiatric and/or neuropsychological damage. We report data on six patients claiming harm, 4 of whom revealed a long history of somatization by history and psychological testing, and 2 of whom were shown to be malingering based on multiple indicators of non-credible performance. Of the 6 patients, only the 2 somatoform patients who were also depressed showed credible evidence of neuropsychological dysfunction. We review two other studies that have examined the link between mold exposure and cognitive impairment and discuss their limitations in view of the presenting behaviors of these 6 patients. Until the literature has established a credible link between mold and neuropsychiatric/neuropsychological impairment, jurists and clinicians must consider the ethics and potential harm of exposing somatoform patients to multiple unwarranted medical evaluations. Principles for forensic evaluations in this special population are reviewed.
Notes
Note. Rey 15-Item Test: cutoff < 9.
Rey 15-Item Test plus Recognition Trial: cutoff < 20 (Boone, Salazar, et al., Citation2002).
Rey-Osterrieth Equation: cutoff ≤ 47 (Lu, Boone, Cozolino, & Mitchell, Citation2003).
b Test: E score cut-off ≥ 150; omissions cutoff > 50 (Boone, Lu, & Herzberg, Citation2002a).
Rey Word Recognition Test: cutoff ≤ 7 for women, ≤ 5 for men (Nitch et al., in press).
Warrington Recognition Memory Test—Words: cutoff < 33 (Iverson & Franzen, Citation1994).
Dot Counting: E score cut-off ≥ 17; grouped time cutoff > 6″ (Boone, Lu, & Herzberg, Citation2002b).
Rey-Osterrieth/Rey Auditory Verbal Learning Test discriminant function: cutoff < 40 (Sherman, Boone, Lu, & Razani, Citation2002).
Reliable Digit Span: cutoff ≤ 6 (Babikian, Boone, Lu, & Arnold, in press).
Digit Span Age Corrected Scaled Score: cutoff ≤ 5 (Babikian, Boone, Lu, & Arnold, Citation2006).
Digit Span Time to Repeat 3-digit string: cutoff > 2″ (Babikian, Boone, Lu, & Arnold, in press).
Tapping Dominant: cutoff ≤ 35 for men, ≤ 28 for women (Arnold et al., Citation2005).
*Designates failed performance.
This paper is dedicated to the memory of Milton H. Miller, M.D.