Two commonly used symptom validity tests are the Test of Memory Malingering (TOMM) and Word Memory Test (WMT). After examining TOMM–WMT failure concordance rates, Green [Green, P. (2007). Making comparisons between forced-choice effort tests. In K. B. Boone (Ed.), Assessment of feigned cognitive impairment (pp. 50–77). New York: Guilford] urged widespread adoption of the WMT, arguing the TOMM is insensitive to feigned impairment. But Green (2007) used a skewed concordance method that favored WMT (one TOMM subtest vs. three WMT subtests). In the present study we compare pass/fail agreement rates with different combinations of TOMM and WMT subtests in 473 persons seeking compensation for predominately mild neurological trauma. We replicated Green (2007) using his asymmetrical method, but otherwise we found the WMT and TOMM produce comparable failure rates in samples at-risk for exaggeration with balanced comparison (three TOMM subtests vs. three WMT). Further work is necessary to compare WMT and TOMM specificities, as failure concordance designs establish reliability but are insufficient for proving validity.
Assessment of test-taking effort with symptom validity tests (SVTs) is a feature of modern neuropsychological testing (Boone, 2007 and Larrabee, 2007). Neurological injury is a context where benefits can potentially be gained by feigning functional impairment. Financial incentive has proven association with outcome in remote head injury (Binder & Rohling, 1996; Rohling, Binder, & Langhinrichsen-Rohling, 1995) and chronic pain (Bianchini, Curtis, & Greve, 2006; Harris, Mulford, Solomon, van Gelder, & Young, 2005). Other justifications for SVT use include malingering base rates sufficiently high to justify validity testing in patients with ambiguous neurological injury (Greiffenstein & Baker, 2006; Greiffenstein, Baker, & Gola, 1994; Greve, Bianchini, Black, et al., 2006; Greve, Bianchini, & Doane, 2006; Larrabee, 2005; Mittenberg, Patton, Canyock, & Condit, 2002; Ord, Greve, Bianchini, & Curtis, 2007) and a professional consensus that adequate assessment of response validity is fundamental to neuropsychological assessment (Bush et al., 2005). However, sufficient justification for SVT use creates a new issue: Choice of particular SVT. There are many SVTs with variations in method (forced choice, level of performance) and stimulus content (verbal, pictorial) (Bianchini, Mathias, & Greve, 2001), including Test of Memory Malingering (TOMM; Tombaugh, 1995; Tombaugh, 2002), Word Memory Test (WMT; Green, Lees-Haley, & Allen, 2002), Victoria Symptom Validity Test (Slick, Hopp, Strauss, & Spellacy, 1996), Rey Fifteen Item Test (Frederick, 2003), and many others (Boone, 2007). There are too few comparative studies to guide choice.
