Frederick Richard I, Bowden Stephen C
Department of Psychology, US Medical Center for Federal Prisoners, Springfield, Missouri 65807, USA.
J Head Trauma Rehabil. 2009 Mar-Apr;24(2):105-22. doi: 10.1097/HTR.0b013e31819b1210.
This study uses a new method to summarize diagnostic validity information to explore which constructs are captured by malingering tests. The Test Validation Summary applies mixed-groups validation to investigate the meaning of test constructs and to estimate test classification characteristics when test validation groups are not "pure" criterion groups (ie, "compliant" vs "malingering"), but members have variable probability of malingering. The method permits the use of tests with relatively low validity to validate tests of greater validity. In our initial analysis, we argue that the Rey 15-Item Memory Test is best construed as an "intention test" (capturing the intention of testtakers when taking a test) as opposed to an "effort test." Using the Test Validation Summary and mixed-groups validation, we demonstrate that as an indicator of "intention to feign cognitive impairment," the Rey 15-Item Memory Test has estimated false-positive rate (FPR) = 0.02 and true-positive rate (TPR) = 0.57. We then explore the meaning of failure on the Word Memory Test (WMT), which uses a dichotomous classification of performance as valid or invalid. Although the WMT is commonly referred to as an "effort test," we argue that it likely captures both "intention" and "effort" but collapses this information into a single dichotomous classification of symptom validity. We demonstrate that, as a result of this dichotomous classification process, the WMT likely has a problematic FPR. In our analysis of previously published WMT data, the WMT FPR is estimated at 0.12 when there is no predisposition to perform poorly but rises dramatically and unrealistically as the predisposition to perform poorly increases. We compare these findings to those of the Validity Indicator Profile (VIP), which captures both intent and effort to classify 4 different sorts of response styles in cognitive testing. In our analyses, the VIP demonstrates that FPR = 0 and TPR = 0.86 when the construct being measured is "intent to perform poorly," and reveals that FPR = 0.06 and TPR = 0.63 when the construct being measured is "inconsistent responding" or "poor effort." We were able to demonstrate for the VIP the same "oversensitivity" shown by the WMT when the VIP was interpreted only as a dichotomous classification test. These results indicate that researchers who attempt to generate classification characteristics for malingering tests must carefully consider what constructs are being captured by the test.
本研究采用一种新方法来总结诊断效度信息，以探究伪装测试所捕捉的是哪些结构。测试效度总结运用混合组验证来研究测试结构的意义，并在测试验证组并非“纯粹”的标准组（即“配合者”与“伪装者”）而是成员具有不同伪装概率时，估计测试分类特征。该方法允许使用效度相对较低的测试来验证效度更高的测试。在我们的初步分析中，我们认为雷伊15项记忆测试最好被理解为一种“意图测试”（捕捉测试者在进行测试时的意图）而非“努力测试”。使用测试效度总结和混合组验证，我们证明，作为“伪装认知损伤意图”的指标，雷伊15项记忆测试估计的假阳性率（FPR）=0.02，真阳性率（TPR）=0.57。然后我们探究词语记忆测试（WMT）失败的意义，该测试使用表现有效或无效的二分法分类。尽管WMT通常被称为“努力测试”，但我们认为它可能同时捕捉了“意图”和“努力”，只是将这些信息合并为症状效度的单一二分法分类。我们证明，由于这种二分法分类过程，WMT可能具有有问题的假阳性率。在我们对先前发表的WMT数据的分析中，当没有表现不佳的倾向时，WMT的假阳性率估计为0.12，但随着表现不佳倾向的增加，该比率会急剧且不切实际地上升。我们将这些发现与效度指标剖面图（VIP）的发现进行比较，VIP在认知测试中捕捉意图和努力以对4种不同的反应风格进行分类。在我们的分析中，当所测量的结构是“表现不佳的意图”时，VIP显示假阳性率=0，真阳性率=0.86；当所测量的结构是“不一致反应”或“努力不足”时，VIP显示假阳性率=0.06，真阳性率=0.63。当仅将VIP解释为二分法分类测试时，我们能够证明它与WMT表现出相同的“过度敏感”。这些结果表明，试图生成伪装测试分类特征的研究人员必须仔细考虑测试所捕捉的是哪些结构。
