Test of Memory Malingering (Tomm) Trial 1 as a Screening Measure for Insufficient Effort

Abstract

The identification of insufficient effort is critical to neuropsychological evaluation, and several existing instruments assess effort on neuropsychological tasks. Yet instruments designed to detect insufficient effort are underutilized in standard neuropsychological assessments, perhaps in part because they typically require significant administration time and are, therefore, not ideally suited to screening contexts. The Test of Memory Malingering (TOMM) is a commonly administered, well-validated symptom validity test. This study evaluates the utility of TOMM Trial 1 as a relatively brief screening measure of insufficient effort. Results suggest that TOMM Trial 1 demonstrates high diagnostic accuracy and is a viable option for screening insufficient effort. Diagnostic accuracy estimates are presented for a range of base rates. The need for more comprehensive SVT assessment in most clinical and forensic situation is discussed.

ACKNOWLEDGMENTS

This work was supported in part by the Department of Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center. It was additionally supported with resources and the use of facilities at the Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey Veterans Affairs Medical Center. The first author is currently located at Texas Tech University Health Sciences Center, Department of Neuropsychiatry and Behavioral Sciences, Lubbock, Texas. The New Orleans VA Medical Center is now part of the Southeast Louisiana Veterans Healthcare System. Jennifer Kleiner is now located in the Department of Psychiatry at the University of Arkansas Medical School.

Notes

¹As an example of an exception, in cases of relatively severe dementia, standard cut-scores might be inappropriate depending on the severity of impairment (Teichner & Wagner, 2004). Additionally, questions of such impairment cannot be answered by results of SVTs, but rather must be addressed by evaluation of presenting complaints, patient history (including nature and progression of illness/trauma as well as neuroimaging and other medical findings), caregiver report, and neuropsychological test results.

CS = Cut-score, SN = Sensitivity, SP = Specificity, BR = Base rate, PPV = Positive predictive value, NPV = Negative predictive value. To calculate percentages multiply PPV and NPV results by 100.

CS = Cut-score, SN = Sensitivity, SP = Specificity, BR = Base rate, PPV = Positive predictive value, NPV = Negative predictive value. To calculate percentages multiply PPV and NPV results by 100.