Department of Physical Medicine and Rehabilitation, University of Colorado Denver School of Medicine, 80045, USA.
Psychol Assess. 2012 Mar;24(1):36-45. doi: 10.1037/a0024628. Epub 2011 Jul 18.
If an examinee exerts inadequate effort to perform well during a psychological or neuropsychological exam, the resulting data will represent an inaccurate representation of the individual's true abilities and difficulties. In adult populations, methodologies to identify noncredible effort have grown exponentially in the last 2 decades. Though a comparatively modest amount of work has focused on tools to identify noncredible effort in pediatric populations, recent research has demonstrated that children can consistently pass several stand-alone symptom validity tests (SVTs) using cutoffs established with adults. However, no identified studies have examined the implications of pediatric SVT failure for ability-based test performance. The current sample consisted of 276 children aged 8-16 years referred consecutively for outpatient clinical neuropsychological consultation following mild traumatic brain injury (TBI). An earlier subgroup of this same case series that also included 17-year-olds was presented in Kirkwood and Kirk (2010). Nineteen percent of the current sample performed below the actuarial cutoff on the Medical Symptom Validity Test (MSVT). No background or injury-related variable differentiated those who passed from those who failed the MSVT. Performance on the MSVT was correlated significantly with performance on all ability-based tests and explained 38% of the total ability-based test variance. Participants failing the MSVT performed significantly worse on nearly all neuropsychological tests, with large effect sizes apparent across most tests. The results provide compelling evidence that practitioners should add objective SVTs to the evaluation of school-aged youth, even when secondary gain issues might not be readily apparent and particularly following mild TBI.
如果受检者在心理或神经心理检查中未能充分努力表现，那么得出的数据将不能准确反映个体的真实能力和困难。在成年人群体中，过去 20 年来，已经有很多方法可以识别不可信的努力。虽然有相当数量的工作集中在识别儿童群体不可信努力的工具上，但最近的研究表明，儿童可以使用与成人建立的临界值一致地通过几种独立的症状有效性测试（SVTs）。然而，没有已确定的研究探讨了儿童 SVT 失败对基于能力的测试表现的影响。本研究样本包括 276 名年龄在 8 至 16 岁的儿童，他们因轻度创伤性脑损伤（TBI）连续接受门诊临床神经心理咨询。Kirkwood 和 Kirk（2010）曾报告过该研究系列的一个早期亚组，其中也包括 17 岁的儿童。当前样本中有 19%的儿童在医学症状有效性测试（MSVT）的计算截点以下。没有背景或与伤害相关的变量可以区分通过和未通过 MSVT 的人。MSVT 的表现与所有基于能力的测试的表现显著相关，解释了总基于能力测试变异的 38%。在 MSVT 测试失败的参与者在几乎所有神经心理学测试中表现明显更差，大多数测试中都显示出较大的效应量。研究结果提供了有力的证据，表明即使在没有明显的次要收益问题的情况下，尤其是在轻度 TBI 后，临床医生也应该在对学龄期儿童的评估中添加客观的 SVTs。
