The Case for Assessing for Negative Response Bias, Not Malingering

ABSTRACT

Assessment of response style is a vital component of forensic assessment. However, the focus on malingering in the literature and test offerings has predictable and negative consequences: Because the label of malingering is viewed as toxic, tests designed to assess for it are often long and sacrifice sensitivity to minimize false-positive errors. Rather than focusing on diagnosing or ruling out malingering, examiners and validity test authors can focus on detecting negative response bias that could invalidate other clinical and forensically relevant data. Doing so can avoid overstepping one’s data and stigmatization, allow shorter, more cost-efficient assessments, better inform the court, reduce inherent conflicts of interest, and lessen conflict surrounding the response style issue.

KEYWORDS:

• Malingering
• negative response bias
• feigning
• assessment
• forensic
• competency

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

¹ Sum of feigning (24.1%), factitious disorders (1.2%), somatoform and conversion disorders (1.9%), and lack of cooperation (8.7%) = 35.9%. This assumes each condition is distinct from each other, which may not be the case.

² Many examiners may avoid using the term “malingerer” (Martin, Schroeder, & Odland, 2015), yet be willing to mention malingering as a possible explanation for the poor performance. Some readers of the report, particular prosecutors, are likely to see the difference as trivial and when given the chance equate one with the other. My view is that examiners should especially avoid using the malingerer label, as it implies a stable trait when usually there is no evidence of this.

³ Alternatively, the report writer might affirmatively state that the examiner did not attempt to evaluate the validity of the defendant’s presentation and that this remains an open question. Absent this, the attorneys and court may mistakenly assume that the reported symptom or cognitive deficits were accepted as legitimate by the examiner.

⁴ A clear effect size for the MSVT is not readily obtained because of some unusual features of its literature. Several studies have focused on specificity in challenging groups such as intellectual disability and dementia, and the MSVT has performed very well if profile analysis is used. Estimates of sensitivity have ranged from .90 to 1.00 without profile analysis and from .40 to .766 with it (Rubenzer, 2018). However, Chafetz and Biondolillo (2013) noted many feigning examinees obtain a genuine memory impairment profile on the MSVT, and that low IQ examinees who are motivated to perform well do not fail the primary effort indicators, and clearly pass the test. Most sensitivity estimates have been obtained in a personal injury context, where examinees tend to feign more subtly than criminal defendants, so it is quite likely the MSVT has an effect size comparable to the other validity tests cited in this paper.