psychological assessment of symptom and performance validity

Psychological Assessment of Symptom and PerformanceValidity, Response Bias, and Malingering: Official Positionof the Association for Scientific Advancement in PsychologicalInjury and Law

Shane S. Bush & Robert L. Heilbronner & Ronald M. Ruff

Received: 20 May 2014 /Accepted: 22 July 2014 /Published online: 17 August 2014# Springer Science+Business Media New York 2014

Abstract Evidence-based forensic psychological opinions re-quire thorough and accurate information about examinees.Psychometric instruments can facilitate diagnostic decisionmaking, but they rely on examinees to respond honestly toquestions and put forth good effort on cognitive tests. Giventhe strong incentives for examinees in psychological injury casesto minimize prior problems and emphasize postaccident orposttrauma problems, the assessment of validity as part offorensic psychological evaluations is essential. Best practicesin forensic psychology have their foundation in ethical princi-ples. The purpose of this position statement is to promote ethicalpsychological practice in legal contexts by reviewing validityassessment issues and their ethical foundations. Because nopreviously published document focused specifically on symp-tom and performance validity assessment in psychological inju-ry evaluations performed in forensic contexts, such a positionstatement provided by a professional organization devoted to theinterface of psychological injury and law was needed to informand guide practitioners and to educate other interested parties.The position statement emphasizes (a) the need for ethicalpractice in assessing validity, (b) consideration of factors suchas culture and functional limitations, and (c) the importance ofadopting a comprehensive, impartial, and scientific approach tovalidity assessment. The position statement acknowledges areasof differing opinions and the need for further research.

Keywords Symptom validity . Response bias .Malingering .

Consensus statement .ASAPIL .Psychological injuryand law

Introduction

Background

Psychologists have long understood the importance of havingthorough and accurate information about patients when mak-ing diagnostic decisions, establishing treatment protocols, andmaking treatment recommendations. Psychometric instru-ments such as personality inventories can facilitate diagnosticdecision making, but they rely on valid information from, orabout, the person being assessed. Thus, it is important forexaminees to respond honestly, rather than minimizing, exag-gerating, or fabricating problems, or denying or minimizingcommon human weaknesses and faults. Similarly, for psycho-logical tests of cognition, examinees must put forth adequateeffort for the results to be considered a reliable and validreflection of the constructs of interest (attention, memory,etc.). With valid test results, psychologists can interpret thefindings as they relate to the construct being assessed. Withoutvalid test results, there is reduced confidence in the inferencesthat can be drawn from the test results regarding the constructof interest.

To help establish whether examinees have responded in areliable and valid manner, some early standardized psycho-logical inventories, such as the Minnesota MultiphasicPersonality Inventory (MMPI; Hathaway & McKinley,1943), included validity scales. Given their primary impor-tance, interpretation of the validity scales was established asthe first step in the test data interpretation process. Because ofan increasing appreciation of the necessity of determiningresponse validity, particularly in forensic contexts, newer

S. S. Bush (*)Long Island Neuropsychology, P.C., Stony Brook University Schoolof Medicine, Lake Ronkonkoma, NY, USAe-mail: [email protected]

R. L. HeilbronnerChicago Neuropsychology Group, Northwestern UniversityFeinberg School of Medicine, Chicago, IL, USA

R. M. RuffSan Francisco Clinical Neurosciences, University of California, SanFrancisco, CA, USA

Psychol. Inj. and Law (2014) 7:197–205DOI 10.1007/s12207-014-9198-7

instruments and subsequent editions of the MMPI have in-creasingly focused on validity scales (see Heilbronner &Henry, 2013 for a review). While such scales can help psy-chologists determine the reliability and validity of the resultsof a given test, a multi-method approach is used to determinethe validity of an examinee’s overall approach to an evalua-tion. Such methods commonly include some combination ofthe following: psychometric measures with validity scales,free-standing validity measures, indices embedded withincognitive ability tests, behavioral observations, informationobtained from records, and interviews of the examinee andcollateral sources. Interpretation of multiple validity assess-ment methods within a structured framework (e.g., Slick,Sherman, & Iverson, 1999) facilitates the decision-makingprocess.

Although examinees may produce invalid test results inclinical contexts for a variety of reasons (Iverson, 2006), thepresence of strong incentives for examinees to misrepresenttheir true psychological functioning increases the importanceof validity assessment in forensic contexts. For example, insome persons with a history of mild traumatic brain injury,litigation status has been found to affect symptom complaints,cognitive test performance, and recovery outcome (Binder &Rohling, 1996; Feinstein et al., 2001).

The Need for a Position Statement

Position statements emphasizing the necessity of assessingsymptom and performance validity and the importance ofusing a multi-method approach for neuropsychological eval-uations have been published in the United States by theNational Academy of Neuropsychology (Bush et al. 2005a,2 005b 1 ) a nd Ame r i c a n Ac ad emy o f C l i n i c a lNeuropsychology (Heilbronner et al., 2009). Additionally,the Specialty Guidelines for Forensic Psychology (AmericanPsychological Association, 2013), although not solely devot-ed to validity issues, state, “As with testimony regardingforensic examinees, the forensic practitioner strives to identifyany substantive limitations that may affect the reliability andvalidity of the facts or opinions offered, and communicatesthese to the decision maker” (Guideline 4.02.02: ExpertTestimony by Practitioners Providing Therapeutic Services).These Guidelines further state, “Forensic practitioners consid-er and seek to make known that forensic examination resultscan be affected by factors unique to, or differentially presentin, forensic contexts including response style…” (Guideline10.02: Selection and Use of Assessment Procedures). TheBritish Psychological Society (2009) also published a position

statement supporting the importance of assessing effort inclinical evaluations of cognition.

These prior position statements provide valuable guidanceto psychologists and other interested parties; however, nopreviously published document focuses specifically on symp-tom, performance, and response validity assessment that ispertinent for all psychological evaluations performed in fo-rensic contexts. Thus, such a position statement provided by aprofessional organization devoted to the interface of psycho-logical injury and law was needed to inform and guide prac-titioners and to educate other interested parties. The purposeof the present statement is to promote sound psychologicalpractice in legal contexts by reviewing validity assessmentissues and their ethical foundations. This position statement isintended to be aspirational.

Procedure

The president of the Association for Scientific Advancementin Psychological Injury and Law (ASAPIL), GeraldYoung, Ph.D., and other members of the ASAPIL boardof directors identified the need for a position statementon this topic. The primary authors, with publicationhistories involving ethical, forensic, and symptom andperformance validity topics, were invited by Dr. Youngto create the position statement. The statement was thensent to the entire Psychological Injury and Law (PIL)editorial board for review and comment. Final editswere made by the primary authors, and the final docu-ment was approved by the ASAPIL board of directors.None of the authors serves on the ASAPIL board ofdirectors.

Ethical Foundations of Validity Assessment

The assessment of symptom and performance validity,like other aspects of psychological practice, is based onprofessional ethics. Ethical principles represent theshared values of the profession and, as such, providethe moral foundation for professional behavior.Healthcare professions and professional organizationshave described and widely adopted the following fourbioethical principles: (1) respect for patient autonomy,(2) nonmaleficence, (3) beneficence, and (4) justice(Beauchamp & Childress, 2009). Additional principleshave been proposed and described, but these fourcomprise the core of many ethics codes, including theAmerican Psychological Association (2010) EthicalPrinciples of Psychologists and Code of Conduct (APAEthics Code).

1 The National Academy of Neuropsychology position statement wastranslated into German and published in two German journals (Bushet al. 2006a, 2006b, Bush et al. 2007).

198 Psychol. Inj. and Law (2014) 7:197–205

The APA Ethics Code builds upon the four bioethicalprinciples, providing the following five general princi-ples to help guide psychologists’ choices and behaviors:(1) beneficence and nonmaleficence, (2) fidelity andresponsibility, (3) integrity, (4) justice, and (5) respectfor people’s rights and dignity. Ten additional ethicals tandards provide more speci f ic guidance forpsychologists. Iverson (2006) and Bush (2009, 2013)previously described the ethical bases of validity assess-ment, primarily targeted toward neuropsychology practi-tioners but also relevant for clinical psychologists.Iverson concluded, “Careful assessment of effort andthe accuracy of symptom reporting underlies proper testinterpretation. The central issues, from an ethical per-spective, relate to competence, objectivity, clarity incommunication, and the proper use of tests” (p. 84).Using the APA Ethics Code as the primary resourcefor ethical information, Bush (2009) identified the fol-lowing ethical standards as being particularly relevantfor validity assessment: Boundaries of Competence(Standard 2.01), Bases for Scientific and ProfessionalJudgments (Standard 2.04), Bases for Assessments(Standard 9.01), Informed Consent (Standards 3.10 and9.03), Deception (in the context of research, Standard8.07), Use of Assessments (Standard 9.02), ExplainingAssessment Results (Standard 9.10), and Avoidance ofFalse or Deceptive Statements (Standard 8.10) whenreporting validity assessment results.

The present paper utilizes the APA General Principlesto structure the review of ethical issues in validityassessment and to explain the ethical considerations thatunderlie various aspects of the validity assessment pro-cess. Although the APA General Principles were used inthis paper, numerous ethical, legal, and scholarly re-sources exist to guide decision making and behavior inforensic pract ice (Bush et al . 2006a, 2006b) .Consideration of multiple resources can facilitate thedecision-making process and improve outcomes.

Beneficence and Nonmaleficence

The goal of providing psychological services is to benefit theconsumers of the services, while minimizing the potential forharmful outcomes for examinees, other involved parties, andthe profession of psychology. These closely related ethicalprinciples serve as the foundation for ethics codes, practiceguidelines, regulations, and other tenets governing the behav-ior of psychologists. As a result, these principles also informpsychologists engaged in forensic activities when makingdecisions about validity assessment practices. Practicing in amanner that is consistent with these principles does not implythat psychological conclusions or legal outcomes must befavorable to the examinee or retaining party; rather, the benefit

and the avoidance of harm relate intimately to the legal pro-cess, triers of fact, and the public at large.

Failure to adequately assess symptom and performancevalidity and to interpret and report the findings of a psycho-logical evaluation as accurately as possible can result in mis-leading information being conveyed to the triers of fact orother legal or administrative decisionmakers. Such a failure tofollow current standards of practice can be harmful to the fact-finding process and the persons involved in legal matters andcan waste valuable resources. In addition to assessing symp-tom and performance validity, forensic psychologists strive toassess response validity, which is the accuracy of the exam-inee’s responses to autobiographical questions (e.g., educa-tional history, vocational history, legal history) and questionspertaining to the legal matter in question (e.g., the nature of,and events surrounding, an injury, crime, or traumatic event).Assessing consistencies between examinee responses and re-cords can inform practitioners about response validity. Inforensic psychology, use of a multi-method approach to va-lidity assessment that includes appropriate psychometric mea-sures is consistent with sound ethical practice.

Despite the advances made in the assessment ofvalidity and feigning, significant construct validity is-sues remain, especially around the issue of intentionality(e.g., whether the examinee’s problems are consciouslyor unconsciously exaggerated or minimized). Comparedto more traditional psychodiagnostic and cognitive tests,which have been refined and well-researched over manydecades, measures of performance and symptom validityare still in their relative infancy. The initial method ofdefining poor effort as test scores that fall significantlybelow chance has been improved by establishing nor-mative data for known diagnostic groups, simulationgroups, and nonclinical populations. However, as withother areas of psychological research, methodologicaldifficulties exist in validity assessment research. Forexample, simulation studies have students or other vol-unteers fake poor performances on tests. The scoresfrom such studies then serve as cutoff scores for themeasures used in the studies. However, few of theperformance validity test manuals or articles providetest-retest reliability to examine how reliably volunteersfake their performances or how closely simulated per-formance corresponds to that of actual examinees whogenerate invalid results. Additionally, some comparisongroups are comprised of mixed patient samples or pop-ulations that are of minimal similarity to a given exam-inee, which may not allow for appropriate comparisonsfor a given examinee according to the established cutoffscores.

Even when the cutoff scores are reliable and valid,no test can capture the intent underlying the examinee’sinvalid results. Invalid results may be consciously or

Psychol. Inj. and Law (2014) 7:197–205 199

unconsciously generated by examinees. The strongestevidence for inferring intentionally poor performancecomes from scores on forced choice tests that are sig-nificantly below chance (i.e., significantly less than50 % correct), which occurs relatively infrequently.Thus, determinations regarding validity tend to be bestsupported by use of appropriate comparison groups.However, even when evidence clearly indicates that anexaminee intentionally performed poorly, test results bythemselves cannot explain why. Because no tests havebeen developed that can capture malingering per se in areliable and valid manner, caution is indicated wheninferring meaning from scores that fall in ranges thatare consistent with invalid performance. Use of proba-bilistic language (e.g., possible, probable, definite) basedon structured diagnostic criteria is advisable when con-sidering determinations of malingering (Slick et al.,1999). Alternatively, conceptualizing invalid results asrepresenting feigning is preferred to malingering inmany situations because it makes no assumptions re-garding the reasons for which the examinee generatedinvalid results (Rogers, 2008).

Fidelity and Responsibility

Psychologists are advised to establish trust with thosewith whom they interact in their professional roles. Inforensic contexts, establishing trust does not alwaysimply that examinees trust that examiners will advocatefor their needs. Rather, examinees and retaining partiesshould trust that the psychologist will perform the re-quested services as accurately and objectively as possi-ble. Establishing trust and rapport involves psycholo-gists being open with all parties about the nature ofthe evaluation, including the inclusion of validity as-sessment methods and procedures and the importanceof responding honestly and putting forth good efforton tests.

Consistent with the Law of No Surprises (Behnke,Perlin, & Bernstein, 2003), all parties are best servedwhen psychologists explain in advance the nature of theservices that will be provided. Psychologists should notexplain the specific nature of validity assessment mea-sures or procedures, indicate to examinees when suchmeasures will be used, or otherwise educate examineesor their advocates in a way that could be used tomanipulate the results. The appropriate selection, use,interpretation, and reporting of validity assessment mea-sures and results is consistent with best practices, whichpromotes an atmosphere of trust. It can be advantageousto explain that the results may or may not be favorableto the examinee or retaining party. Psychologists strive

to make the forensic examinee comfortable so that theexaminee is afforded every opportunity to approach theevaluation in a manner which maximizes the chance forobtaining reliable and valid results. Psychologists under-stand that there is continuum of symptom reporting thatranges f rom overrepor t ing or exaggera t ing tounderreporting or denial of symptoms. In the assessmentof symptom validity, psychologists have a responsibilityto consider both ends of the spectrum, and the fullrange in between. It is also important to considerwhether examinees are presenting themselves as overlyvirtuous, without common human weaknesses or faults.

Because of concern for the ethical conduct of col-leagues, psychologists should take advantage of oppor-tunities to educate colleagues about the importance ofvalidity assessment as an essential component of foren-sic evaluations. Directing colleagues to the positionstatements on validity assessment published by profes-sional organizations can be a valuable component of theeducation process. Additionally, psychologists maychoose to discuss with colleagues that some validitystudies and measures can have poor construct validityand poor operationalization of constructs and that posi-tion statements need to be guided by the best availableevidence.

Integrity

Psychologists performing forensic evaluations promoteaccuracy, honesty, and truthfulness from the initial con-tact with the retaining party throughout the completionof the service. Because interpretation of invalid testperformances is made by examiners, it is essential thatexaminers are aware of their own biases. This aware-ness can be achieved only if examiners make an effortto identify their biases. With biases identified, exam-iners can strive to reduce the effects of the biases ontheir opinions. Just as it is important for a psychother-apist to examine countertransference, it is imperativethat examiners explore their thoughts and feelings aboutexaminees, especially in the context of litigation (Ruff,2009).

The topic of external incentives is typically focusedon examinees. However, external incentives may beapplied to forensic examiners as well, in large partbecause the pay for psychological services in someforensic contexts is substantially higher than the ratefor routine clinical work. In many instances, psycholo-gists retained by plaintiff attorneys can receive morereferrals if they document deficits that are not taintedby invalid responding or performance. Similarly, psy-chologists who are retained by the defense in civil cases


can often increase their referral base if the results ofvalidity measures identify a high percentage of theircases as having produced invalid results, often attributedto inadequate effort or feigning. Thus, clinicians strivingto practice in an ethical manner make efforts to explorehow their personality characteristics, political orienta-tion, cognitive dissonance, and other sources of biasaffect the selection and interpretation of validity assess-ment measures and take steps to minimize the impact ofbias.

Use of empirical research to guide test selection and inter-pretation promotes accuracy. Psychologists understand thatthe most empirically sound evidence often comes from studiespublished after the test manuals are published. Use ofdebiasing techniques (Sweet & Moulthrop, 1999) helps psy-chologists maximize objectivity in the interpretation andreporting of assessment results. The value of such techniquesis dependent on a corresponding personal value system de-voted to honesty. Psychologists must not alter their validityassessment practices or reporting solely based on which sidehas retained their services for a given case.

Justice

Psychologists who perform forensic evaluations strive toensure fairness and equality in access to services, theprocess and procedures employed, and the services pro-vided. While different types of forensic evaluations maynecessitate the use of different validity measures orprocedures, psychologists recognize the importance ofequality within a specific type of forensic evaluation.Consideration of personal biases, such as disregard forthe value of validity assessment, helps psychologistsidentify limitations in their practices and promotes fair-ness in their professional activities. Failure to considerpersonal biases and boundaries of competence can resultin unjust practices and outcomes.

Respect for People’s Rights and Dignity

Psychologists practicing in forensic contexts, like all psychol-ogists, respect the rights and dignity of those with whom theywork. Such respect is demonstrated by providing services thatare consistent with best practices. Best practices in forensicpsychological evaluations include multi-method, evidence-based validity assessment. Such assessment takes into accountcharacteristics of the examinee, such as language preference,race, and objective functional limitations, which may have animpact on the assessment or interpretation process.

Psychologists also demonstrate respect for the rightsand dignity of forensic examinees through the informedconsent or notification of purpose process. In such

processes, psychologists inform examinees that theyare to respond truthfully and put forth good effort ontests. Psychologists also inform examinees and retainingparties that validity measures will be used, although thespecific nature of such measures or the timing of theiruse is not disclosed. While use of measures that appearto measure mood, personality traits, or cognitive abili-ties but actually measure validity may be considered atype of deception of examinees, such deception is nec-essary to establish the validity of the assessment resultsand to accurately inform the trier of fact, and psychol-ogists satisfy ethical responsibilities in the informedconsent process through the explanation in generalterms that validity measures will be used (seeAppendix for a sample informed consent form).

Additionally, dimensions of diversity, especially lan-guage, cultural factors, and disability status, are oftenunderrepresented in validity research, and validity as-sessment instruments are often not validated on diversesamples. Practitioners are well served by consideringsuch issues in their selection, use, and interpretation ofvalidity assessment measures and procedures and iden-tify these limitations in their reports.

Recommendations for Forensic Practitioners

1. Strive to be familiar and practice consistent withrelevant practice, ethical, and legal/legislative re-quirements pertaining to validity assessment, includ-ing the present statement and extant position state-ments (e.g., Bush et al. 2005a, 2005b; Heilbronneret al., 2009).

2. Only validity measures having appropriate psychometricproperties are used, selected based on the characteristicsof the examinee and the circumstance(s) for which theexaminee is referred.

3. List all validity measures and psychometric indicatorsused but avoid describing them in detail.

4. Interpretations of the results of assessment measuresare based on consideration of all the relevant reli-able assessment data, and then considered with thefull data set (e.g., from examinee interview, collat-eral sources, records). These other data sets mightcontain substantial inconsistencies or discrepancies.The conclusions that best fit the full data set areoffered in opinions and testimony, independent ofthe desires of the referral source.

5. Be wary of inferring motivation, volition, intention,and consciousness when there is insufficient evi-dence. However, do not avoid making such


judgments when sufficient evidence is available.Consistently using preferred inferences, such asfeigning or a “cry for help,” can be unhelpful ormisleading in individual cases unless the evidenceoverwhelmingly supports such a conclusion.

6. Use of validity measures and indicators is maxi-mized when practitioners understand the variousitems and definitions, and how to resolve inconsis-tencies therein in their conclusions. Understandinginconsistencies within and across relevant ethicscodes, professional guidelines, practice regulations,legal/legislative frameworks, and position statements,enables practitioners to address them effectively incourt.

7. Repeatedly check for biases and incentives in one’sown practices and conclusions. Internal or externalinfluences that detract from an unbiased approach toevaluations need to be considered and countered. Itis the forensic practitioner’s responsibility to guardagainst biases and strive to maintain a balancedperspective.

Conclusions

Forensic psychological practice has its foundations inethical principles. Such principles guide professionalchoices and underlie every forensic opinion. Evidence-based forensic psychological opinions require thoroughand accurate information about examinees. Psychometricmeasures can be an important part of the forensic eval-uation process, but obtaining accurate information aboutthe constructs of interest requires examinees to approachevaluations in a valid manner, responding honestly toquestions and putting forth good effort on cognitivetests. Given the strong incentives for examinees in legalcases to minimize prior problems and emphasize post-accident or posttrauma problems, the assessment of va-lidity as part of forensic psychological injury evalua-tions is essential. Best practices in forensic psychologi-cal evaluations consist of a multi-method, evidence-based validity assessment process that includes psycho-metric measures of validity.

The selection, use, and interpretation of the results ofthe validity assessment measures are the responsibilityof the practitioner. Psychologists performing forensicevaluations should consider the limits of the normativedata, comparison groups, computer printouts, and otherinformation associated with the assessment measuresand their interpretation, aware that the strongest

evidence of a measure’s utility often emerges fromstudies performed after the initial publication of the testmanual. When faced with invalid results and consider-ing making determinations of malingering, it is advis-able to use probabilistic language or a term such asfeigning that make no assumptions regarding examineegoals which underlie the production of invalid results.

In addition to the potential for examinee bias inforensic psychological evaluations, there are oftenstrong incentives for practitioners to provide evaluationresults that favor the retaining party. Biased selection,use, or interpretation of validity assessment results cansubstantially influence a practitioner’s conclusions inrelation to the retaining party’s needs. Psychologistsmust consider their own potential biases and take stepsto maximize objectivity. Being able to describe theevidence bases supporting one’s forensic opinions andto explain why possible alternative forensic opinionswere rejected can help promote objectivity.

In all aspects of the validity assessment process,ethical psychologists are guided by a personal commit-ment to (1) provide beneficial services to examinees,retaining parties, the trier of fact or other decisionmaker, and society at large; (2) minimize the potentialfor harm to examinees, other involved parties, the legalor administrative system, and the profession of psychol-ogy which could arise from unprofessional practices; (3)inspire trust from others that the requested psychologicalservices will be performed as accurately and objectivelyas possible; (4) promote accuracy, honesty, and truthful-ness in all aspects of the services provided, includingconsidering and minimizing their own biases; (5) striveto ensure fairness and equality in access to services, theprocess and procedures employed, and the services pro-vided; and (6) demonstrate respect for the rights anddignity of those with whom they work by providingservices that are consistent with best practices, includingbeing forthcoming with examinees about the inclusionof validity assessment and considering diversity issues.Psychological evaluations have much to offer legal andadministrative decision makers when psychologists areguided by an understanding of foundational ethical prin-ciples and a personal commitment to high standards ofethical practice.

Acknowledgments The authors wish to express appreciation to Drs.Bradley N. Axelrod, Louise Ferretti, Michael Gottlieb, AndrewW. Kane,Izabela Z. Schultz, Rodney D. Vanderploeg, and Gerald Young and fortheir review and comments.

Conflicts of Interest We collectively have no conflicts of interest toreport and represent no organization other than ASAPIL.


Appendix

Sample Informed Consent Form*Forensic Psychological Evaluation**


*This is a general template for informed consent that may not apply to all circumstances or jurisdictions. Practitioners may bewell served by seeking advice from personal counsel to determine if this consent is appropriate for their circumstances orjurisdiction and modify as needed.**Adapted from the sample consent form for independent neuropsychological evaluations provided by the National Academy ofNeuropsychology (Bush et al. 2005a, 2005b).

References

American Psychological Association. (2010). Ethical Principles ofPsychologists and Code of Conduct (EPPCC). Retrieved fromhttp://www.apa.org/ethics/code/index.aspx

American Psychological Association. (2013). Specialty guidelines forforensic psychology. American Psychologist, 68, 7–19.

Beauchamp, T. L., & Childress, J. F. (2009). Principles of biomedicalethics (6th ed.). New York: Oxford University Press.

Behnke, S. H., Perlin, M. L., & Bernstein, M. (2003). Theessentials of New York Mental Health Law: a straightforwardguide for clinicians of all disciplines. New York: W.W. Norton &Company.

Binder, L. M., & Rohling, M. L. (1996). Money matters: a meta-analyticreview of the effects of financial incentives on recovery after closedhead injury. American Journal of Psychiatry, 153, 5–8.

British Psychological Society. (2009). Assessment of effort in clinicaltesting of cognitive functioning for adults. Leicester, UK: Author

Bush, S. S. (2009). Symptom validity assessment practices: ethical andprofessional considerations (Die praxis der beschwerdenvalidierung:ethische und fachwissenschaftliche gesichtspunkte). In T. Merten &H. Dettenborn (Eds.), Assessment of Malingering (Diagnostik derBeschwerdenvaliditat) (pp. 79–100). Berlin, Germany: DeutscherPsychologen Verlag.

Bush, S. S. (2013). Ethical considerations in mild traumatic brain injurycases and symptom validity assessment. In D. A. Carone & S. S.Bush (Eds.), Mild Traumatic Brain Injury: Symptom Validity


http://www.apa.org/ethics/code/index.aspx

Assessment and Malingering (pp. 45–56). New York: SpringerPublishing Company.

Bush, S. S., Barth, J. T., Pliskin, N. H., Arffa, S., Axelrod, B. N.,Blackburn, L. A., & Silver, C. H. (2005a). Independent and court-ordered forensic neuropsychological examinations: official state-ment of the National Academy of Neuropsychology. Archives ofClinical Neuropsychology, 20, 997–1007.

Bush, S. S., Ruff, R.M., Troster, A. I., Barth, J. T., Koffler, S. P., & Silver, C.H. (2005b). Symptom validity assessment: practice issues and medicalnecessity. Archives of Clinical Neuropsychology, 20, 419–426.

Bush, S. S., Connell, M. A., & Denney, R. L. (2006a). Ethical Issues inforensic psychology: a systematic model for decision making.Washington, D.C.: American Psychological Association.

Bush, S. S., Ruff, R.M., Tröster, A. I., Barth, J. T., Koffler, S. P., & Silver,C. (2006b). Diagnostik der beschwerdenvalidität: praktischegesichtspunkte und medizinische erfordernisse. Neurologie undRehabilitation, 12, 69–74.

Bush, S. S., Ruff, R.M., Tröster, A. I., Barth, J. T., Koffler, S. P., & Silver,C. (2007). Diagnostik der beschwerdenvalidität: praktischegesichtspunkte und medizinische erfordernisse. Praxis derRechtspsychologie, 17, 155–163.

Feinstein, A., Ouchterlony, D., Somerville, J., & Jardine, A. (2001). Theeffects of litigation on symptom expression: a prospective studyfollowing mild traumatic brain injury. Medical Science and theLaw, 41, 116–121.

Hathaway, S. R., &McKinley, J. C. (1943).Manual for administering andscoring the MMPI. Minneapolis, MN: University of Minnesota Press.

Heilbronner, R. L., & Henry, G. K. (2013). Psychological assessment ofsymptom magnification in mild traumatic brain injury cases. In D.A. Carone & S. S. Bush (Eds.), Mild Traumatic Brain Injury:Symptom Validity Assessment and Malingering (pp. 183–202).New York: Springer Publishing Company.

Heilbronner, R. L., Sweet, J. J., Morgan, J. E., Larrabee, G. J.,Millis, S. R., & Conference Participants. (2009). AmericanAcademy of Clinical Neuropsychology Consensus ConferenceStatement on the neuropsychological assessment of effort,response bias, and malingering. The Clinical Neuropsychologist,23, 1093–1129

Iverson, G. L. (2006). Ethical issues associated with the assessment ofexaggerat ion, poor effort , and malingering. AppliedNeuropsychology, 13, 77–90.

Rogers, R. (2008). An introduction to response styles. In R. Rogers (Ed.),Clinical assessment of malingering and deception (3rd ed., pp. 3–13). New York: Guilford Press.

Ruff, R. (2009). Best practice guidelines for forensic neuropsychologicalexaminations of patients with traumatic brain injury. The Journal ofHead Trauma Rehabilitation, 24, 131–140.

Slick, D. J., Sherman, E. M., & Iverson, G. L. (1999). Diagnostic criteriafor malingered neurocognitive dysfunction: proposed standards forclinical practice and research. The Clinical Neuropsychologist, 13,545–561.

Sweet, J. J., & Moulthrop, M. A. (1999). Self-examination questions as ameans of identifying bias in adversarial assessments. Journal ofForensic Neuropsychology, 1, 73–88.


psychological assessment of symptom and performance validity

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