KEVIN J. BIANCHINI, PH.D., ABPN

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1 KEVIN J. BIANCHINI, PH.D., ABPN

2 Slick et al., 1999 Bianchini et al., 2005

4 4 4

7 Criterion A: Evidence of significant external incentive Criterion B: Evidence from physical evaluation 1. Probable effort bias 2. Discrepancy between subjective report of pain and physiological reactivity 3. Non-organic findings 4. Discrepancy between the patient s physical presentation during formal evaluation and their physical capacities documented when they are not aware of being observed Criterion C: Evidence from cognitive/perceptual (neuropsychological) testing 1. Definite negative response bias 2. Probable response bias 3. Discrepancy between cognitive/neuropsychological test data and known patterns of brain functioning 4. Discrepancy between test data and observed behavior Criterion D: Evidence from self-report 1. Compelling inconsistency 2. Self-reported history is discrepant with documented history 3. Self-reported symptoms are discrepant with known patterns of physiologic or neurological functioning 4. Self-reported symptoms are discrepant with observations of behavior 5. Evidence from formal psychological evaluation that the person has significantly misrepresented their current status Criterion E: Behavior meeting necessary criteria from groups B, C, and D are not fully accounted for by psychiatric, neurological or developmental factors 7 7

8 I. Definite MPRD Presence of substantial external incentive [Criterion A] Definitive evidence of intent [Criterion C1 or D1] Behaviors meeting the criteria for definitive intent [C1 or D1] are not fully accounted for by psychiatric, neurological or developmental factors. [Criterion E] II. Probable MPRD Evidence of significant external incentive [Criterion A] Two or more types of probable evidence of intent from Criterion B [B1-B5], Criterion C [C2-C5] and/or Criterion D [D2-D6]. This evidence must be well-validated and have a known error rate. Behavior meeting necessary criteria from groups B, C, and D are not fully accounted for by psychiatric, neurological or developmental factors. [Criterion E] III. Possible MPRD Evidence of significant external incentive [Criterion A] Evidence does not rise to the level sufficient for a diagnosis of Probable MPRD. Only one type of quantitative probable evidence of intent from Criterion B [B1-B5], Criterion C [C2-C5] and/or Criterion D [D2-D6]. OR One or more forms of qualitative evidence of intent from Criterion B [B1-B5], Criterion C [C2-C5] and/or Criterion D [D2-D6]. OR Evidence sufficient for a diagnosis of MPRD is present BUT Criterion E is not met. 8 8

9 More symptoms (SVTs) Worse performances on measures of ability (PVTs)

11 The majority (54%) of these patients had traumatic brain injuries (TBI) with neuroimaging evidence of intracranial injury and/or Glasgow Coma Scale scores in the moderate or severe range (scores less than 13). None of the head trauma patients were in the mild category.

12 Most of the remaining brain dysfunction patients (31% of the total of 120) had medically intractable epilepsy confirmed by intensive EEG monitoring and 14% had a variety of other diagnoses with neurologic evidence and brain injury.

13 PDRT Cutoff Scores Easy Items Hard Items Total Score 19 Correct 18 Correct 39 Correct Cutoff Scores are the worst scores obtained among 120 adult patients without financial incentives who had unambiguous evidence of brain dysfunction

14 Classification Accuracy of the Portland Digit Recognition Test in Traumatic Brain Injury: Results of a known-groups Analysis Greve, K., & Bianchini, K. The Clinical Neuropsychologist 2006:20:

20 % Positive Effort Test Self-Report Malingering No Inc State WC Federal WC Bianchini, K. J., Curtis, K. L., & Greve, K. W. (2006). Compensation and Malingering in Traumatic Brain Injury: A Dose-Response Relationship? The Clinical Neuropsychologist, 20,

21 20 Odds Ratio State WC Federal WC Effort Test Self-Report Malingering Bianchini, K. J., Curtis, K. L., & Greve, K. W. (2006). Compensation and Malingering in Traumatic Brain Injury: A Dose-Response Relationship? The Clinical Neuropsychologist, 20,

23 Detecting Malingering in Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice Symptom Validity Tests Greve, K., Ord, J., et al. The Clinical Neuropsychologist 2008:22:

26 Detecting Malingered Pain-Related Disability: Classification Accuracy of the Portland Digit Recognition Test Greve, K., Bianchini, K., et al. The Clinical Neuropsychologist 2009:23:5,

29 Detecting Malingering in Traumatic Brain Injury and Chronic Pain: A Comparison of Three Forced-Choice Symptom Validity Tests Greve, K., Ord, J., et al. The Clinical Neuropsychologist 2008:22:

32 Classification Accuracy of MMPI-2 Validity Scales In the Detection of Pain-Related Malingering: A Known-Groups Study Bianchini, K., Etherton, J., et al. Assessment 2008:15:

38 Prevalence of Malingering in Patients With Chronic Pain Referred for Psychologic Evaluation in a Medico-Legal Context Greve, K., Ord, J., et al. Archives of Physical Medicine and Rehabilitation 2009:90:117-26

41 A. Studied Indicators Only B. Could Set Criteria Level (Based on False Positive Error Rates) C. Titration of the use of this evidence with objective medical evidence of damage

42 D. Require adherence to a diagnostic system E.. If these approaches are applied system wide, there will be efforts to avoid detection strategies can be put in place to counteract this

43 F. Once in place, a program of research could be undertaken to study the uses of these methods & the extent of the problem of disability exaggeration with this population

Donald A. Davidoff, Ph.D., ABPDC Chief, Neuropsychology Department, McLean Hospital Assistant Professor of Psychology, Harvard Medical School

Donald A. Davidoff, Ph.D., ABPDC Chief, Neuropsychology Department, McLean Hospital Assistant Professor of Psychology, Harvard Medical School Interests: Adult/Geriatric/Forensic Neuropsychology ddavidoff@mclean.harvard.edu