تشخیص تمارض: یک بررسی از شیوه های کارشناسان

A survey addressing practices of ‘expert’ neuropsychologists in handling financial compensation claim or personal injury litigation cases was carried out. Potential participants were identified by publication history. Responses were obtained from 24 out of the 39 neuropsychologists who were surveyed. Approximately 79% of the respondents reported using at least one specialized technique for detecting malingering in every litigant assessment. Half stated that they always give specialized tests at the beginning of the assessment. The Rey 15-Item test and the Test of Memory Malingering were the most frequently reported measures. Respondents also reported frequent use of ‘malingering’ indexes from standard neuropsychological tests. Reported base-rates varied, but the majority of respondents indicated that at least 10% of the litigants they assessed in the last year were definitely malingering. Respondents were split on the practice of routinely giving warnings at the outset of assessments that suboptimal performance may be detected. However, when the client’s motivational status was suspect, more than half (58.3%) altered their assessment routine at least on some occasions, by encouraging good effort (70.8%) or administering additional SVTs. A minority directly confronted or warned clients (25%), terminated the examination earlier than planned (16.6%), or contacted the referring attorney immediately (29.2%). Respondents almost always stated some opinion regarding indicators of invalidity in written reports (95%). However, 41.7% rarely used the term ‘malingering’ and 12.5% never used the term. Most respondents (>80%) instead stated that the test results are invalid, inconsistent with the severity of the injury or indicative of exaggeration.

Neuropsychologists often play an important role in personal injury litigation concerning brain damage. Given the importance of their opinions, neuropsychologists require reliable and valid measures, not just of cognitive functions and psychosocial adjustment, but also of symptom exaggeration or malingering. Of equal importance to the tools used is the way in which they are employed. Studies have shown that the outcome of the examination can be influenced by factors such as the choice of tests (e.g., Gervais, Green, & Allen, 1999), the order in which tests are given (Guilmette, Hart, Sparadeo, Buongiorno, & Whelihan, 1996), and the use of warnings that exaggerated deficits can be detected (e.g., Johnson & Lesniak-Karpiak, 1997 and Johnson & Lesniak-Karpiak, 1997; Youngjohn, Lees-Haley, & Binder, 1999).