Neuropsychologists' ability to predict distorted symptom presentation.
OBJECTIVE
We explored to what extent experienced neuropsychologists can predict distorted symptom presentation of clinically referred hospital outpatients.


METHODS
Using clinical files and interview results, 31 neuropsychologists made predictions as to how 203 patients would perform on two response validity tests. Their predictions were matched against actual passing or failing two such tests, of which one measured overreporting of symptoms and the other underperformance on cognitive tests.


RESULTS
Clinical predictions and test outcomes agreed in 76% of the cases, with Cohen's kappa being .26, 95% confidence interval, CI [.08, .44]. Of the 152 patients for whom neuropsychologists had predicted nondistorted symptom presentations, 14 patients (9.2%) failed both response validity tests. Of the 51 patients for whom neuropsychologists had predicted problematic response validity, 35 patients (68.6%) passed both tests.


CONCLUSIONS
Clinical prediction of distorted symptom presentation is far from perfect. Our findings show that response validity tests have incremental value in that they may correct initial clinical judgment.
a Department of Medical Psychology , Maastricht University Medical Centre, School for Mental Health and Neuroscience , Maastricht , The Netherlands.
Brechje
B
Dandachi-FitzGerald
b Forensic Psychology Section , Maastricht University , Maastricht , The Netherlands.
Harald
H
Merckelbach
a Department of Medical Psychology , Maastricht University Medical Centre, School for Mental Health and Neuroscience , Maastricht , The Netherlands.
Rudolf W H M
RW
Ponds
D000293:Adolescent; D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008306:Malingering / Q000175:diagnosis*; D008569:Memory Disorders / Q000175:diagnosis*; D008875:Middle Aged; D009483:Neuropsychological Tests; D015203:Reproducibility of Results; D055815:Young Adult
Amsterdam Short Term Memory Test (ASTM); Clinical judgment; Hospital outpatients; Performance validity; Structured Inventory of Malingered Symptomatology (SIMS); Symptom validity.