The Clinical neuropsychologist
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Comparative Study
The relationship between suboptimal effort and post-concussion symptoms in children and adolescents with mild traumatic brain injury.
This retrospective chart review study explored the relationship between suboptimal effort and post-concussion symptoms in pediatric mild traumatic brain injury (mTBI). Participants were 382 clinically referred children and adolescents between 8 and 16 years of age who sustained an mTBI. Suboptimal effort was identified using reliable digit span and age-corrected scaled scores from the Numbers subtest of the Children's Memory Scale (CMS); 20% of the sample were classified as non-credible performers. ⋯ Additionally, non-credible performers demonstrated comparatively poorer performance on neuropsychological tests of focused attention and processing speed. These results suggest that children and adolescents with mTBI who fail effort testing might have a greater tendency to exaggerate post-concussion symptoms and cognitive impairment. The clinical implications of these findings are discussed.
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The Modified Somatic Perception Questionnaire (MSPQ) and the Pain Disability Index (PDI) are both popular clinical screening instruments in general orthopedic, rheumatologic, and neurosurgical clinics and are useful for identifying pain patients whose physical symptom presentations and disability may be non-organic. Previous studies found both to accurately detect malingered pain presentations; however, the generalizability of these results is not clear. This study used a criterion groups validation design (retrospective cohort of patients with chronic pain, n = 328) with a simulator group (college students, n = 98) to determine the accuracy of the MSPQ and PDI in detecting Malingered Pain Related Disability. ⋯ However, they accurately differentiated Not-MPRD from MPRD cases. Diagnostic statistics associated with a range of scores are presented for application to individual cases. Data from this study can inform the clinical management of chronic pain patients by screening for psychological overlay and malingering, thus alerting clinicians to the possible presence of psychosocial obstacles to effective treatment and triggering further psychological assessment and/or treatment.
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Since the early 2000s concern has increased that college students might feign ADHD in pursuit of academic accommodations and stimulant medication. In response, several studies have validated tests for use in differentiating feigned from genuine ADHD. Although results have generally been positive, relatively few publications have addressed the possible impact of the presence of psychological disorders comorbid with ADHD. ⋯ Two clinical groups (ADHD only and ADHD + comorbid psychological disorder) were contrasted with two non-clinical groups (normal controls answering honestly and normal participants feigning ADHD). Extending previous research to individuals with ADHD and either an anxiety or learning disorder, performance validity tests such as the Test of Memory Malingering (TOMM), the Letter Memory Test (LMT), and the Nonverbal Medical Symptom Validity Test (NV-MSVT) were effective in differentiating both ADHD groups from normal participants feigning ADHD. However, the Digit Memory Test (DMT) underperformed in this study, as did embedded validity indices from the Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Woodcock Johnson Tests of Achievement-III (WJ-III).
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The study aimed to examine the reliability and validity of the Turkish version of the Montreal Cognitive Assessment Scale (MoCA-TR) as a screening tool for cognitive dysfunction in Parkinson's disease (PD). A total of 50 patients with PD and 50 healthy controls were included. The screening instruments-MoCA-TR followed by the Mini-Mental Status Examination (MMSE-TR) and MoCA-TR retest within 1 month-and detailed neuropsychological testing were administered to the PD patients. ⋯ With a cut-off score of < 21 points, the MoCA-TR showed sensitivity of 59% and specificity of 89% in the detection of cognitive dysfunction in PD. The area under the receiver-operating characteristics curve (95% confidence interval) for MoCA-TR was 0.794 (0.670-0.918), p<.001. The present results indicated that the MoCA-TR has acceptable psychometric properties and it should be used to assess mild cognitive impairment and early dementia in PD patients, whereas the MMSE-TR should remain the instrument of choice to assess cognitive impairment in PD dementia.
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Fibromyalgia is a chronic pain-related disorder that typically includes cognitive complaints as well as non-specific somatic complaints, such as fatigue and sleep disturbance (Wolfe et al., 2010). Fibromyalgia has also been shown to be associated with a high rate of failure on performance validity testing (PVT), which has not been examined with respect to other self-reported symptoms that are now part of the diagnostic criteria for the disorder. We evaluated 85 patients with fibromyalgia who completed objective measures of pain, sleep, and fatigue along with symptom validity measures (Word Memory Test or Test of Memory Malingering and Reliable Digit Span). ⋯ Disability status analyses were significant for daily pain, weekly pain, and fatigue, but not sleep. The implication of this study is that PVT performance and disability status are associated with exaggeration of non-cognitive symptoms such as pain, sleep, and fatigue in persons with fibromyalgia. This study reinforces the importance of effort testing when working with medical populations.