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Abstract
The purpose of this study was to evaluate the clinical utility of the Rarely Missed Index (RMI) to detect cognitive exaggeration in 78 nonlitigant patients (i.e., Mixed Clinical group) and 158 personal injury litigants (i.e., 20 Suspected Exaggerators, 12 Borderline Exaggerators, 126 Genuine Responders). The base rate for probable malingered neurocognitive dysfunction in the litigant sample was 12.7%. The false positive error rate of the RMI in the Genuine Responder and Mixed Clinical group ranged from 5.4% to 8.6%. Positive RMI scores were found in 25% and 41.7% of the Suspected Exaggerator and Borderline Exaggerator groups respectively. The clinical utility of the RMI to identify Suspected Exaggerators versus individuals in the Genuine Responder and Mixed Clinical groups revealed low sensitivity (sensitivity = .25), very high specificity (range = .91 to .95), moderate positive predictive power (range = .50 to .71), and moderate to high negative predictive power (range = .68 to .83). These results do not support the use of the RMI as a reliable predictor of cognitive exaggeration.
This study was supported in part by a research grant from the Queensland University of Technology, Brisbane, Australia
Notes
This study was supported in part by a research grant from the Queensland University of Technology, Brisbane, Australia
Data in this study was independent of that reported by CitationLange et al. (2003).
The data collected for this study was obtained from referrals during 1998 to 2003. In earlier years, the standard practice of the clinicians did not include administration of well-validated symptom validity tests (e.g., TOMM) unless concerns were raised during testing regarding motivation. On many occasions the Rey 15 item test was administered. However, given the demonstrated limitations of this test, individuals who were administered the Rey 15 Item test were excluded. It is acknowledged that this criterion for exclusion may ultimately produce a selection bias towards the inclusion of individuals who are more likely to be exaggerating. However, analysis of the data using the entire sample did not change the results or conclusions of this investigation. Data pertaining to the entire sample can be obtained from the authors on request.