Confronting Patients About Insufficient Effort: The Impact on Subsequent Symptom Validity and Memory Performance

Abstract

Symptom validity tests (SVTs) are commonly used to assess effort in neuropsychological evaluations. However, no empirical research or official guidelines exist about how clinicians should proceed if a patient produces a non-valid SVT result. The purpose of this study was to examine whether confronting patients immediately after scoring in a non-valid range on a SVT would have an impact on subsequent symptom validity and memory tests performance. Archival patient data for 507 adults with clinically definite multiple sclerosis (MS) (ages 18–76) were examined. All patients completed the Victoria Symptom Validity Test (VSVT), the Wechsler Memory Scale, 3rd edition (WMS III), and the Beck Depression Inventory, 2nd edition (BDI II). Although the majority (89%) of patients produced valid VSVT scores (the Valid group), 56 patients produced non-valid VSVT scores. Due to a change in clinical procedure, 28 of the 56 were confronted regarding their non-valid VSVT performances and were asked to complete the test a second time (the CONF group), while the remaining 28 proceeded with testing as usual following a non-valid score (the N-CONF group). Results showed that 68% of the CONF group produced valid VSVT scores on re-administration, as well as memory performances that were comparable to those of the Valid group. In contrast the N-CONF group produced memory scores that were significantly below the Valid group. This is the first study to provide empirical support for the effectiveness of intervention when patients exhibit inadequate effort on SVTs in clinical, non-forensic settings.

Keywords:

• Symptom validity tests
• Effort testing
• Memory testing
• Depression
• Multiple sclerosis
• Malingering
• Victoria Symptom Validity Test
• Neuropsychological evaluation

Acknowledgments

The study was approved by Institutional Review Board (IRB) at the Cleveland Clinic Foundation. Data were drawn from an IRB-approved neuropsychological registry of MS patients while one of the authors (GJC) was employed at the Cleveland Clinic Foundation. The results of the current study were presented in part as a poster at the 34th annual conference of the International Neuropsychological Society meeting, February 2006, Boston, MA.