Introduction to special issue on effort testing in children and adolescents

Abstract

This manuscript reviews the past history of effort testing in children and adolescents. Results in children and adults are briefly described on tests such as the Word Memory Test (WMT), the Medical Symptom Validity Test (MSVT), the Nonverbal Medical Symptom Validity Test (NV-MSVT) and Test of Memory Malingering (TOMM). Articles in the Special Issue are also briefly described.

Keywords:

• Effort testing
• children
• adolescents
• Word Memory Test (WMT)
• Medical Symptom Validity Test (MSVT)
• Nonverbal Medical Symptom Validity Test (NV-MSVT)
• Test of Memory Malingering (TOMM)

Although acceptance of the need for effort testing in children and adolescents often described as Performance Validity Tests (PVTs) has been slow to arrive, work has been going on in this field for many years, laying a solid foundation for the present-day use of PVTs with children. As early as 1996, Dr. Lloyd Flaro hypothesized that children with developmental disabilities would be unable to pass the WMT. However, when he systematically applied the WMT to children, he found that they easily passed it (Green & Flaro, 2003, Green et al., 2012).

The TOMM has been widely used with children, as explained by Dr. Kirk in his paper in this special edition. For example, Constantinou and McCaffrey (2003) investigated whether or not already established effort measures could be used with children. The Test of Memory Malingering (TOMM) and the Rey-15-item test was administered to 128 children in two sites, the USA and Cyprus. The results indicated that the TOMM had the potential to be used as a measure for identifying children who did not put forth maximal effort during neuropsychological evaluations. In contrast, the Rey-15-item test was not found to be a promising measure of effort for use with children, especially younger children.

The Medical Symptom Validity Test (MSVT) (Green, 2004) and Nonverbal MSVT (Green, 2008) test manuals both used samples of disabled children to establish cutoffs for failure, with an emphasis on children with fetal alcohol syndrome. The logic was that if these severely disabled children could pass these recognition tests, almost any child or adult should be able to do so. The first publication on the MSVT included children who spoke no French but who were tested in French. Their mean scores on recognition subtests were the same as those of French-speaking adults (Richman et al., 2006), even though the children did not know the meanings of any of the words. The second MSVT publication included healthy children in grades two to five (Gill et al., 2007), showing that even in the grade two children the median percent correct score on the recognition memory subtests was 100%. By 2012, Green and colleagues described results from over 800 consecutively tested developmentally disabled children, showing that they had very low failure rates on the WMT, MSVT and the Nonverbal MSVT. Green and Flaro (2016) showed that children with intellectual deficits also had no trouble passing the WMT, MSVT, or Nonverbal MSVT.

It had already been shown in adults that effort explained 50% of the variance in the whole neuropsychological test battery, whereas years of education explained only 12%, age explained 3% and severity of brain injury explained 4% (Green et al., 2001). Kirkwood et al. (2012) showed that, even though failure rates on the same PVTs were much lower in children than in adults, the effort still explained 38% of the variance in the test battery. Thus, it was impossible to ignore the fact that effort had major effects on test scores. By the time that Dr. Flaro’s series grew to 1,285 consecutive developmentally disabled children, it was shown that failure on even one of the three PVTs led to significantly suppressed test scores across almost all ability tests in the battery (Green & Flaro, 2019).

Kirkwood et al. (2012) highlighted the idiosyncratic reasons why children fail PVTs. Harrison et al. (2012) gave examples of children whose assessments had failed to include PVTs and where the children suffered as a result. One child was given an IQ in the 80 s and placed in school accordingly. Later testing showed that his IQ was actually 120 but he had not been engaged in the first testing.

In this Special Issue of Applied Neuropsychology—Child, the emphasis is on very recent work on PVTs in children. Dir. Kirk reviews past work on PVTs reinforcing that much work has already been done on the use of PVTs with children. Dr. Nicholls takes a widely used test with children (TOVA) and shows just how large an effect poor effort can have on test scores that would usually be interpreted as reflecting attentional ability. The “Omissions” score, in particular, is greatly affected by the effort applied to test and indicated by PVT failure. It is fortunate to have an independent replication of the same effect in the paper by Drs. Harrison and Armstrong. TOVA scores are so greatly affected by the measured effort that it is clear that TOVA scores should not be interpreted unless thorough performance validity testing has been conducted. Also, Dr. MacAllister describes the results of the MSVT with children with severe seizure disorders. Surprising though it may be, these children easily pass the MSVT, consistent with previous reports by Carone (2014).

In addition, Dr. Teague explores the usefulness of the Rey 15 item test and the TOMM in a sample of children. Dr. Donders also evaluated the utility of abbreviated versions of the TOMM with traumatic brain-injured children. Dr. Erdodi explored the use of verbal fluency and digit span variables as PVTs in an adolescent sample. In the next paper, Drs. Harrison and Armstrong provide a preliminary study on a very new PVT the License Plate Test (LPT) (assesses recognition memory of aspects of 10 imaginary license plates) in Canadian adolescents with learning disabilities. In the last paper, Bosworth and Dodd demonstrate the value of the Nonverbal-Medical Symptom Validity Test (NV-MSVT) in assessing noncredible effort in pediatric mild traumatic brain injury.

As can be seen, this Special Issue on Effort Testing in Children and Adolescents covers a wide range of established PVTs and different diagnostic conditions and some less established PVTs and includes both samples from the USA and Canada. All of the authors are thanks for their kindness in contributing their important work to this Special Issue. Special thanks are due to Rili Muralidharan, our Production Editor and Ailsa Marks, our Portfolio Manager for their outstanding help and support. The hope and expectation are that this Special Issue will significantly contribute to improving the care and treatment of children and adolescents in the future.

Disclosure statement

Dr. Green is the author of the Word Memory Test (WMT), the Medical Symptom Validity Test (MSVT), the Nonverbal Medical Symptom Validity Test (NV-MSVT) and the License Plate Test (LPT) and receives income from the sale of these tests. Dr. Horton was a test consultant for the revision of the Test of Memory Malingering (TOMM) and received an honorarium for his service but does not receive income from sales of the revised TOMM.