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

Abstract

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). 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.

Keywords:

• Malingering
• Social Security Administration (SSA)
• Disability determinations
• Performance validity test (PVT)
• Symptom validity test (SVT)
• Malingered pain-related disability (MPRD).

Disclosure statement

Yossef Ben-Porath is a paid consultant to the MMPI Publisher, the University of Minnesota, and Distributor, Pearson. As co-author of the MMPI-2-RF, he receives royalties on sales of the test.

Drs. Chafetz and Williams both previously derived income for consulting for SSA but no longer do so.

Drs. Boone, Chafetz, Kirkwood, and Larrabee receive royalties from their books mentioned in this publication.

Notes

¹ Means testing involves a determination of whether the person is eligible for benefits based on whether the person or their family has the means to do without the benefits.

² Sensitivity, specificity, base rate, and positive and negative predictive power (PPP and NPP). The diagnostic formula for PPP, which is the certainty of being right when determining malingering with a PVT, is True Positives/(True Positives + False Positives). In the comparison between known malingering groups against credible clinical samples, cut-off scores are set so that approximately 90% of the bona fide impairment group is correctly identified as providing valid performance. The investigator also specifies the clinical characteristics of the 10% false positive cases (e.g., need for 24 h supervised living) so that a clinician utilizing the PVT can see if their examinee possesses characteristics that would indicate false positive identification.