The high potential for secondary gain among college students presenting for Attention-Deficit/Hyperactivity Disorder (ADHD) evaluations highlights the need for psychometrically sound embedded ...validity indicators. The purpose of this study was to develop new validity indicators specific to feigned ADHD for the Personality Assessment Inventory (PAI) and compare them to preexisting imbedded PAI validity measures.
PAI scales that were theoretically related to feigned ADHD were evaluated. A binomial (ADHD simulators, n = 138, and genuine ADHD, n = 142) logistic regression was conducted with selected PAI scales and subscales. Classification rates were compared between the new and existing validity scales. A similar approach was used for item-level data in a second study in a subgroup of the original sample.
The derived PAI scale-based logistic regression had a sensitivity of 54% and specificity of 92%. This algorithm accurately identified 97% of healthy controls as not feigning ADHD and correctly identified 98% of a no diagnosis group and 75% of a mood/anxiety disorders group. Classification accuracy of the new index was superior to the majority of existing PAI validity scales across groups. An item-level PAI algorithm had a sensitivity of 85% and specificity of 97% for identifying feigned ADHD.
New validity measures were compared to existing PAI validity indicators and performed better than many of them in this study. The algorithms developed in this study of ADHD simulators and genuine ADHD cases have adequate sensitivity and good specificity and appear to function differently than other PAI symptom validity scales.
This study examined intra-individual variability in a large sample (n = 629) of individuals with a history of mild traumatic brain injury (mTBI) or TBI referred for neuropsychological evaluation. ...Variability was assessed using the overall test battery mean standard deviation (OTBM SD). We found a negative linear relation between OTBM and OTBM SD (r = -.672) in this sample with a history of neurologic pathology, indicating that the variability is inversely related to cognitive performance and contrary to what is observed in most normative data. Analyses revealed main effects for OTBM and OTBM SD across three TBI severity groups: loss of consciousness (LOC) <1 h, LOC 1 h-6 days, and LOC >6 days. These effects were found for both a valid performance group (no failed embedded validity measures; n = 504) and an invalid performance group (failed one or more embedded validity measures; n = 125). These findings support that cognitive intra-individual variability is increased uniquely by both neuropathology and suboptimal effort, there is a dose-response relationship between neuropathology and cognitive variability, and intra-individual variability may have utility as a clinical index of both.
Classification accuracy for the detection of malingered neurocognitive dysfunction (MND) in mild traumatic brain injury (TBI) is examined for two selected measures from the Conners' Continuous ...Performance Test-II (CPT-II) using criterion-groups validation. Individual and joint classification accuracies are presented for Omissions and Hit Reaction Time Standard Error across a range of scores comparing mild TBI malingering (n = 27), mild TBI not-malingering (n = 31), and moderate-to-severe (M/S) TBI not-malingering (n = 24) groups. At cutoffs associated with at least 95% specificity in both mild and M/S TBI, sensitivity to MND in mild TBI was 30% for Omissions, 41% for Hit Reaction Time Standard Error, and 44% using both indicators. These results support the use of the CPT-II as a reliable indicator for the detection of malingering in TBI when used as part of a comprehensive diagnostic system.
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BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Chronic pain constitutes a lifelong condition for numerous patients and presents a costly public health issue. The aim of this dissertation study was to examine the relation of self-report pain ...scales to neuropsychological test performance. Using exploratory factor analysis, two latent factor(s) of pain were identified: “pain distress” and “pain dysfunction.” Using structural equation modeling, both factors were confirmed and examined in relation to an overall latent factor of cognition (“g”). Greater perceived pain distress and pain dysfunction significantly predicted worse cognition and accounted for 12% of the variance in g. History of sexual abuse moderated the path from pain distress to g, but not the path from pain dysfunction to g. After controlling for effort, the model was found to have slightly (not significantly), better fit. Word Memory Test (WMT) Delayed Recall and Consistency percent correct were found to significantly confound the relationship between pain distress and cognition. Greater perceived pain distress no longer significantly predicted worse cognition while greater perceived dysfunction still significantly predicted worse g. The model now accounted for nearly 50% of the variance seen in g. Multivariate analysis of variance was used to identify whether failure of a performance validity test resulted in reported symptoms of pain falling above established cutoffs. Results revealed a significant effect of type of WMT performance on the combined dependent variable of pain ratings. Separate examination of the dependent variables revealed that WMT performance groups significantly differed in their Pain Catastrophizing Scale scores, but not in other pain scales. Overall, this dissertation study found that latent factors of chronic pain, history of sexual abuse, and poor effort impact cognitive functioning. These findings have numerous implications for patients, the medical community, and resources allocated to provide support to individuals with chronic pain following surgical intervention. The more attempts made to understand exactly how these factors are affecting cognition and exactly who is being affected will only further help to bring the most appropriate aid and services to patients who are suffering from chronic pain.
Previous research found that the general public holds many misconceptions regarding the effects and symptoms of concussion/TBI. The current study utilized surveys from the published literature. ...Participants were recruited online and data were collected using online surveys. Four hundred and fifteen college undergraduates (mean age = 20.63, SD = 5.23; 70% female; and 64% Caucasian) and 153 healthcare professionals (mean age = 43.4, SD = 12.81; 67% female; and 87% Caucasian) were surveyed regarding knowledge of concussion/TBI sequelae and return-to-play guidelines. Using Pearson chi-square analyses, undergraduates performed significantly better than a 1988 general sample. Additionally, healthcare professionals performed better than college undergraduates. Physicians had fewer misconceptions than other healthcare professionals but specific comparisons between physicians and athletic trainers did not reveal significant differences. While healthcare professionals had fewer misconceptions than college undergraduates, there are still areas of consistent inaccuracies in knowledge across healthcare groups that future educational interventions could target.
Cognitive Remediation in Mental Health Hill, Benjamin D.; Sofko, Channing; Boettcher, Anneliese C.
Handbook of Recovery in Inpatient Psychiatry
Book Chapter
Cognitive deficits are common in psychiatric disorders and often represent key components of these conditions. Rehabilitative techniques that focus on improving cognitive functions are generally ...referred to as cognitive remediation. This chapter focuses on an evidence-based review of cognitive remediation in psychiatric disorders with an emphasis on schizophrenia, anorexia nervosa, and the psychiatric sequelae of traumatic brain injury (TBI) and stroke. We also discuss issues professionals should consider when evaluating the research in this area and ways to improve study methodology in cognitive rehabilitation. Cognitive remediation has growing support as an effective intervention for cognitive comorbidities that frequently accompany psychiatric disorders, particularly for individuals with psychotic symptoms. However, further demonstration of treatment efficacy in specific clinical populations is recommended.
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