Erdodi Laszlo A, Rai Jaspreet K
a Department of Psychology , University of Windsor , Windsor , ON , Canada.
Brain Inj. 2017;31(10):1362-1368. doi: 10.1080/02699052.2017.1332386. Epub 2017 Jun 28.
This study investigated the potential of alternative, more liberal cutoffs on Trial 2 of the Test of Memory Malingering (TOMM) to improve classification accuracy relative to the standard cutoffs (≤44).
The sample consisted of 152 patients (49.3% male) with psychiatric conditions (PSY) and traumatic brain injury (TBI) referred for neuropsychological assessment in a medico-legal setting (M = 44.4, M = 11.9 years). Classification accuracy for various TOMM Trial 2 cutoffs was computed against three criterion measures.
Patients with TBI failed TOMM Trial 2 cutoffs at higher rates than patients with PSY. Trial 2 ≤49 achieved acceptable combinations of sensitivity (0.38-0.67) and specificity (0.89-0.96) in all but one comparison group. Trial 2 ≤48 improved specificity (0.94-0.98) with minimal loss in sensitivity. The standard cutoff (≤44) disproportionally traded sensitivity (0.15-0.50) for specificity (0.96-1.00).
One error on TOMM Trial 2 constitutes sufficient evidence to question the credibility of a response set. However, the confidence in classifying a score as invalid continues to increase with each additional error. Even at the most liberal conceivable cutoff (≤49), the TOMM detected only about half of the patients who failed other criterion measures. Therefore, it should never be used in isolation to determine performance validity.
本研究调查了在记忆伪装测验（TOMM）的第二次测试中采用替代性的、更为宽松的临界值相对于标准临界值（≤44）来提高分类准确性的潜力。
样本包括152名患者（49.3%为男性），他们患有精神疾病（PSY）或创伤性脑损伤（TBI），在法医环境中被转介进行神经心理学评估（平均年龄M = 44.4岁，标准差M = 11.9岁）。针对三种标准测量方法计算了TOMM第二次测试不同临界值的分类准确性。
与患有精神疾病的患者相比，创伤性脑损伤患者在TOMM第二次测试临界值上的失败率更高。除一个比较组外，第二次测试≤49在敏感性（0.38 - 0.67）和特异性（0.89 - 0.96）方面实现了可接受的组合。第二次测试≤48提高了特异性（0.94 - 0.98），而敏感性仅有极小损失。标准临界值（≤44）以不成比例地牺牲敏感性（0.15 - 0.50）来换取特异性（0.96 - 1.00）。
TOMM第二次测试中出现一个错误就足以构成质疑反应集可信度的充分证据。然而，将一个分数判定为无效的信心会随着每增加一个错误而持续增加。即使在最宽松的可设想临界值（≤49）下，TOMM也仅检测出约一半在其他标准测量中失败的患者。因此，绝不应单独使用它来确定表现效度。
