A systematic review and meta-analysis of the Test of Memory Malingering in adults: Two decades of deception detection.

The present study, adhering to Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines, is the first systematic review and meta-analysis of the Test of Memory Malingering (TOMM) to examine traditional and alternative cutoffs across Trial 1, Trial 2, and Retention. Search criteria identified 539 articles published from 1997 to 2017. After application of selection criteria, 60 articles were retained for meta-analysis. Classification accuracy statistics were calculated using fixed- and random-effects models. For Trial 1, a cutoff of <42 was found to result in the highest sensitivity value (0.59-0.70) when maintaining specificity at ≥0.90. Traditional cutoffs for Trial 2 and Retention were highly specific (0.96-0.98) and moderately sensitive (0.46-0.56) when considering all available studies and only neurocognitive/psychiatric samples classified by known-groups design. For both trials, a modified cutoff of <49 allowed for improved sensitivity (0.59-0.70) while maintaining adequate specificity (0.91-0.97). A supplementary review revealed that traditional TOMM cutoffs produced >0.90 specificity across most samples of examinees for whom English is not the primary language, but well-below acceptable levels in individuals with dementia. The TOMM is highly specific when interpreted per traditional cutoffs. In individuals not suspected of significant impairment, findings indicate that a less conservative TOMM Trial 2 or Retention cutoff of <49 can be interpreted as invalid, especially in settings associated with higher base rates of invalidity and, thus, higher positive predictive power. A cutoff of <42 on Trial 1 can also be interpreted as invalid in most settings.