Leonhard Christoph
The Chicago School of Professional Psychology at Xavier University of Louisiana, 1 Drexel Dr, Box 200, New Orleans, LA, 70125, USA.
Neuropsychol Rev. 2023 Sep;33(3):604-623. doi: 10.1007/s11065-023-09602-6. Epub 2023 Aug 18.
Forensic neuropsychological examinations to detect malingering in patients with neurocognitive, physical, and psychological dysfunction have tremendous social, legal, and economic importance. Thousands of studies have been published to develop and validate methods to forensically detect malingering based largely on approximately 50 validity tests, including embedded and stand-alone performance and symptom validity tests. This is Part II of a two-part review of statistical and methodological issues in the forensic prediction of malingering based on validity tests. The Part I companion paper explored key statistical issues. Part II examines related methodological issues through conceptual analysis, statistical simulations, and reanalysis of findings from prior validity test validation studies. Methodological issues examined include the distinction between analog simulation and forensic studies, the effect of excluding too-close-to-call (TCTC) cases from analyses, the distinction between criterion-related and construct validation studies, and the application of the Revised Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) in all Test of Memory Malingering (TOMM) validation studies published within approximately the first 20 years following its initial publication to assess risk of bias. Findings include that analog studies are commonly confused for forensic validation studies, and that construct validation studies are routinely presented as if they were criterion-reference validation studies. After accounting for the exclusion of TCTC cases, actual classification accuracy was found to be well below claimed levels. QUADAS-2 results revealed that extant TOMM validation studies all had a high risk of bias, with not a single TOMM validation study with low risk of bias. Recommendations include adoption of well-established guidelines from the biomedical diagnostics literature for good quality criterion-referenced validation studies and examination of implications for malingering determination practices. Design of future studies may hinge on the availability of an incontrovertible reference standard of the malingering status of examinees.
针对患有神经认知、身体和心理功能障碍的患者进行法医神经心理学检查以检测伪装，具有巨大的社会、法律和经济意义。已经发表了数千项研究来开发和验证法医检测伪装的方法，这些方法主要基于大约50种效度测试，包括嵌入式和独立式表现及症状效度测试。这是关于基于效度测试的法医伪装预测中的统计和方法学问题的两部分综述的第二部分。第一部分的配套论文探讨了关键的统计问题。第二部分通过概念分析、统计模拟以及对先前效度测试验证研究结果的重新分析来研究相关的方法学问题。所研究的方法学问题包括模拟模拟与法医研究之间的区别、从分析中排除难以判定（TCTC）病例的影响、与标准相关的验证研究和结构验证研究之间的区别，以及在《诊断准确性研究质量评估修订工具》（QUADAS - 2）首次发表后的大约前20年内发表的所有记忆伪装测试（TOMM）验证研究中应用该工具来评估偏倚风险。研究结果包括模拟研究通常被混淆为法医验证研究，并且结构验证研究经常被呈现为好像它们是标准参照验证研究。在考虑排除TCTC病例后，发现实际分类准确率远低于声称的水平。QUADAS - 2结果显示，现有的TOMM验证研究都有很高的偏倚风险，没有一项TOMM验证研究的偏倚风险较低。建议包括采用生物医学诊断文献中既定的高质量标准参照验证研究指南，并审视对伪装判定实践的影响。未来研究的设计可能取决于是否有考生伪装状态的无可争议的参考标准。
