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slick_etal_1999_malingering_criteria - The Clinical...

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* We thank Dr. Esther Strauss at the University of Victoria, and Dr. David Garron and Dr. Chris Grote, both at Rush-Presbyterian-St. Luke’s Medical Center, for their helpful comments on an early draft of this paper. Address correspondence to Elisabeth M.S. Sherman, Ph.D., Psychology Department, British Columbia’s Chil- dren’s Hospital, 4480 Oak St., Vancouver, B.C., V6H 3V4, Canada. E-mail: [email protected] Accepted for publication: November 2, 1998. The Clinical Neuropsychologist 1385-4046/99/1304-545$15.00 1999, Vol. 13, No. 4, pp. 545-561 © Swets & Zeitlinger FORUM Diagnostic Criteria for Malingered Neurocognitive Dysfunction: Proposed Standards for Clinical Practice and Research* Daniel J. Slick 1 , Elisabeth M.S. Sherman 2 , and Grant L. Iverson 3,1 1 Riverview Hospital, 2 British Columbia’s Children’s Hospital, and 3 University of British Columbia ABSTRACT Over the past 10 years, widespread and concerted research efforts have led to increasingly sophisticated and efficient methods and instruments for detecting exaggeration or fabrication of cognitive dysfunction. Despite these psychometric advances, the process of diagnosing malingering remains difficult and largely idiosyncratic. This article presents a proposed set of diagnostic criteria that define psychometric, behav- ioral, and collateral data indicative of possible, probable, and definite malingering of cognitive dysfunc- tion, for use in clinical practice and for defining populations for clinical research. Relevant literature is reviewed, and limitations and benefits of the proposed criteria are discussed. Currently, a large proportion of referrals for neuropsychological assessment is being gener- ated by personal injury litigation, worker’s com- pensation, and other systems in which those be- ing referred may receive substantial financial rewards for demonstrating cognitive deficits, either legitimate or successfully feigned. Often, neuropsychological data, reports, and expert testimony strongly influence final decisions about the size of financial settlements. Neuro- psychologistsarethereforeincreasinglyrequired to explicitly evaluate the likelihood that ob- served cognitive deficits are real or feigned. This task is highly problematic not only because those who feign deficits actively attempt to pre- vent detection, but also because of the high indi- vidual and systemic costs of both false-negative and false-positive errors. Given these circum- stances it is surprising that a set of specific, clearly articulated, and clinically applicable cri- teria for rating the likelihood that a patient is malingering neurocognitive dysfunction is not in widespread use. As well as facilitating clinical practice and professional communication, such criteria would also greatly facilitate systematic research about malingering.
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