مقیاس امتیاز: تمارض در آزمون تامین اجتماعی مشاوره ای معلولیت

In disability examinations, benefits may depend on the findings of a psychological consultative examination (PCE), which in Louisiana usually involves a mental status examination and a Wechsler Scale. The disability determinations service (DDS) requires a warning that failure to do one's best may result in an unfavorable decision on the claim, but psychologists are officially discouraged from determining effort by the use of formal effort tests. Consequently, there is a need for internal indicators of effort. Formal testing of effort was undertaken in order to identify indicators of effort within the PCE in WAIS-age and WISC-age claimants. Our findings indicated that the total score of indicators was more predictive of effort than any single indicator. Regression equations yielded information on how much effort contributes to IQ. Classification accuracy for the new rating scale was described for a “dose-response” of effort. Disincentives for malingering detection in the PCE were identified.

Social security disability compensation is dependent in part on the findings of the psychological consultative examination (PCE). The disability determinations service (DDS) office requires that a written warning be given to the claimant. This warning states, “Failure to do your best on these tests may result in an unfavorable decision on the claim.” Moreover, psychologists must also include a statement of the validity of their test findings, and the Social Security examiners often ask psychologists to comment on malingering. However, official guidance from Disability states: “SSA's position is that results derived from tests of malingering are not programmatically useful in determining if an individual meets the SSA definition of disability” (Medical Liaison Officer, personal communication). Indeed, the term “malingering” is not found in the entire Blue Book publication (US Dept. of Health and Human Services, 1994, revised 2006). The finding of malingering on the PCE is a serious event, as it constitutes an allegation of fraud by a claimant who is seeking compensation from the government for problems that are allegedly disabling. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV, American Psychiatric Association, 1994), “malingering is the intentional production of false or grossly exaggerated physical and psychological symptoms for external incentives such as obtaining monetary compensation…”. Although one may conceive of the needy claimant within an adaptational model (Rogers, 1990) in which the claimant is struggling to adapt to indifference or opposition to his or her needs, it is not the stated purpose of the social security disability system to provide compensation when a compensable disability does not exist. The seriousness of the problem can be brought into perspective when one considers the total estimated outlay of Social Security Administration Disability Insurance in 2004 was $80.33 billion. In addition, the projected outlay for Disability Insurance benefits for the old age survivors and disability insurance (OASDI) program in 2004 was $77.95 billion, and the 2004 Supplemental Security Income outlay was $37.36 billion (Social Security Administration, 2003). The base rate range of malingering in private disability cases is estimated to be 30% (Mittenberg, Patton, Canyock, & Condit, 2002). If the base rate of malingering in the public-sector disability determinations is as high as in the private sector, then a large amount of money likely is being spent on fraudulent claims.