Neuropsychologists have long understood that valid examinee performance is needed in order to understand the constructs of interest that are at the heart of clinical and forensic evaluations. The ...assessment of performance validity has evolved over time, from very rudimentary and subjective clinical impressions of examinee task engagement to psychometrically based, multi-method, algorithm-driven, and consensus-informed approaches. Christoph Leonhard has further advanced that evolution in a meaningful way, forcing us to reconsider much of what we thought we knew about the psychometric assessment of performance validity. Although a structured, systematic, and objective approach to validity assessment is necessary, Leonhard has brought to our attention some significant concerns that need to be addressed. This commentary describes professional, ethical, and legal implications of Leonhard’s articles. Through an ongoing process of examining, revising, and improving our methods and procedures, we will be better positioned to provide services of value to those we serve. Leonhard has provided an opportunity for us to do just that.
Professional ethics guide appropriate professional conduct through their reflection of the shared values of the profession. Professional ethics codes, such as the American Psychological Association's ...(APA) Ethical Principles of Psychologists and Code of Conduct (henceforth, APA Ethics Code) are intended to provide guidance across psychological activities, contexts, and specialties. As such, they must, by necessity, be rather general in nature. The APA Ethics Code provides aspirational general ethical principles and enforceable ethical standards. Despite the value of these principles and directives, psychologists commonly need more specific guidance for establishing and maintaining ethical practices in their specific professional contexts. The APA Ethics Code acknowledges in its Introduction and Applicability section the broad nature of the code and the importance of considering additional resources. The APA and other professional organizations provide practice guidelines and position statements that clarify appropriate professional behavior in specific aspects of practice. Although all U.S. psychologists are aware of the APA Ethics Code, far fewer are as familiar with the practice guidelines and position statements of professional organizations, and fewer utilize such valuable resources in their ethical decision making. Practice guidelines and position statements from professional organizations complement ethics codes and facilitate ethical decision making.
Public Significance Statement
This article describes the importance of using practice guidelines and position statements from professional organizations to complement ethics codes as essential resources in ethical decision-making. Additionally, it highlights the value of using a structured decision making process when anticipating and addressing ethical challenges in psychological practice.
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CEKLJ, FFLJ, NUK, ODKLJ, PEFLJ
OBJECTIVEMuch of the information about the ethical practice of clinical neuropsychology has focused on North America. Additionally, of the scholarly publications on the intersection of ethical issues ...and cultural diversity practices in neuropsychology, most have focused on North America. The extent to which practitioners in other parts of the world are aware of, and find useful, such information is largely unknown. Similarly, the extent to which North American neuropsychologists are familiar with ethical issues and challenges encountered around the world is unknown. The purpose of this article is to advance the discussion of ethical issues in clinical neuropsychology from an international diversity perspective.METHODThe article presents, via a panel interview format, the thoughts and experiences of a small sample of neuropsychologists who represent all continents except North America (and Antarctica).RESULTSNeuropsychologists across continents share an ethical commitment to providing services that are beneficial, and not harmful, to the recipients of the services. Professional competence is at the heart of such services.CONCLUSIONSThrough continued and expanded dialogue about ethical issues with neuropsychology colleagues around the world, the potential exists for improvement in the provision of effective and compassionate care in our own towns.
Evidence-based forensic psychological opinions require thorough and accurate information about examinees. Psychometric instruments can facilitate diagnostic decision making, but they rely on ...examinees to respond honestly to questions and put forth good effort on cognitive tests. Given the strong incentives for examinees in psychological injury cases to minimize prior problems and emphasize postaccident or posttrauma problems, the assessment of validity as part of forensic psychological evaluations is essential. Best practices in forensic psychology have their foundation in ethical principles. The purpose of this position statement is to promote ethical psychological practice in legal contexts by reviewing validity assessment issues and their ethical foundations. Because no previously published document focused specifically on symptom and performance validity assessment in psychological injury evaluations performed in forensic contexts, such a position statement provided by a professional organization devoted to the interface of psychological injury and law was needed to inform and guide practitioners and to educate other interested parties. The position statement emphasizes (a) the need for ethical practice in assessing validity, (b) consideration of factors such as culture and functional limitations, and (c) the importance of adopting a comprehensive, impartial, and scientific approach to validity assessment. The position statement acknowledges areas of differing opinions and the need for further research.
Rehabilitation professionals provide valuable clinical services to persons who have sustained neurologic injuries and illnesses. Accurate diagnosis and treatment planning require that ...neurorehabilitation professionals base their decisions on true information and genuine patient performance. That is, the patient must have responded honestly to questions and put forth adequate effort on ability measures. When in possession of valid information about the patient's history, symptoms, and abilities levels, clinicians are well positioned to serve the patient. In contrast, inaccurate information and invalid functional presentations lead to misdiagnosis, unhelpful or potentially harmful interventions, and wasted resources. Ethically, consistent with the principles of beneficence and justice, clinicians have a responsibility to use the assessment measures and procedures that are needed to answer clinical questions and provide appropriate services, using and conserving valuable resources in the process. With validity assessment measures and procedures comprising an important part of clinical evaluations, a formal, structured approach to validity assessment promotes ethical practice. Interdisciplinary collaboration in validity assessment in neurorehabilitation contexts can often be more thorough and efficient than evaluations performed by a single discipline.
Symptom exaggeration or fabrication occurs in a sizeable minority of neuropsychological examinees, with greater prevalence in forensic contexts. Adequate assessment of response validity is essential ...in order to maximize confidence in the results of neurocognitive and personality measures and in the diagnoses and recommendations that are based on the results. Symptom validity assessment may include specific tests, indices, and observations. The manner in which symptom validity is assessed may vary depending on context but must include a thorough examination of cultural factors. Assessment of response validity, as a component of a medically necessary evaluation, is medically necessary. When determined by the neuropsychologist to be necessary for the assessment of response validity, administration of specific symptom validity tests are also medically necessary.
Test selection has significant implications for inferences that can be drawn from test data. Some tests undergo revisions, typically to improve their psychometric properties, normative data, ...relevance of stimuli, and ease of administration. Although revisions of psychological and neuropsychological tests are published periodically, little information is available regarding whether or when clinicians should transition to the most recent versions of the tests. The 2002 APA Ethics Code (Standard 9.08b) requires that psychologists not base their assessment or intervention decisions or recommendations "on tests and measures that are obsolete and not useful for the current purpose." However, there is no consensus regarding when tests should no longer be considered acceptable, and there may be sound reasons for delaying or foregoing the purchase and use of new versions of assessment measures. Determining whether or when to transition to a new version of a test can be particularly difficult for clinicians in psychological specialties because it can take years after publication of a revised test for research with special patient populations to be performed and published. As a result, different clinicians may adopt newer versions of tests at different times or elect not to use the newest version, depending on the specific patient population and referral questions. Decisions regarding transitioning to new test revisions should be based on the scientific merits of the tests, not on an arbitrarily defined time frame. Clinicians ultimately must use their judgment regarding which test version is best for a given patient at a given point in time.
Objective: Neuropsychological tests undergo periodic revision intended to improve psychometric properties, normative data, relevance of stimuli, and ease of administration. In addition, new tests are ...developed to evaluate psychological and neuropsychological constructs, often purporting to improve evaluation effectiveness. However, there is limited professional guidance to neuropsychologists concerning the decision to adopt a revised version of a test and/or replace an older test with a new test purporting to measure the same or overlapping constructs. This paper describes ethical and professional issues related to the selection and use of older versus newer psychological and neuropsychological tests, with the goal of promoting appropriate test selection and evidence-based decision making. Method: Ethical and professional issues were reviewed and considered. Conclusions: The availability of a newer version of a test does not necessarily render obsolete prior versions of the test for purposes that are empirically supported, nor should continued empirically supported use of a prior version of a test be considered unethical practice. Until a revised or new test has published evidence of improved ability to help clinicians to make diagnostic determinations, facilitate treatment, and/or assess change over time, the choice to delay adoption of revised or new tests may be viewed as reasonable and appropriate. Recommendations are offered to facilitate decisions about the adoption of revised and new tests. Ultimately, it is the responsibility of individual neuropsychologists to determine which tests best meet their patients' needs, and to be able to support their decisions with empirical evidence and sound clinical judgment.
Veterans with polytrauma have suffered injuries to multiple body parts and organs systems, including the brain. The injuries can generate a triad of physical, neurologic/cognitive, and emotional ...symptoms. Accurate diagnosis is essential for the treatment of these conditions and for fair allocation of benefits. To accurately diagnose polytrauma disorders and their related problems, clinicians take into account the validity of reported history and symptoms, as well as clinical presentations.
The purpose of this article is to describe the assessment of validity with polytrauma Veteran populations.
Review of scholarly and other relevant literature and clinical experience are utilized.
A multimethod approach to validity assessment that includes objective, standardized measures increases the confidence that can be placed in the accuracy of self-reported symptoms and physical, cognitive, and emotional test results.
Due to the multivariate nature of polytrauma and the multiple disciplines that play a role in diagnosis and treatment, an ideal model of validity assessment with polytrauma Veteran populations utilizes neurocognitive, neurological, neuropsychiatric, and behavioral measures of validity. An overview of these validity assessment approaches as applied to polytrauma Veteran populations is presented. Veterans, the VA, and society are best served when accurate diagnoses are made.
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