title: Strategies of successful and unsuccessful simulators coached to feign traumatic brain injury.
abstract: The present study evaluated strategies used by healthy adults coached to simulate traumatic brain injury (TBI) during neuropsychological evaluation.
  
  
  
  Healthy adults (n = 58) were coached to simulate TBI while completing a test battery consisting of multiple performance validity tests (PVTs), neuropsychological tests, a self-report scale of functional independence, and a debriefing survey about strategies used to feign TBI.
  
  
  
  "Successful" simulators (n = 16) were classified as participants who failed 0 or 1 PVT and also scored as impaired on one or more neuropsychological index. "Unsuccessful" simulators (n = 42) failed ≥2 PVTs or passed PVTs but did not score impaired on any neuropsychological index. Compared to unsuccessful simulators, successful simulators had significantly more years of education, higher estimated IQ, and were more likely to use information provided about TBI to employ a systematic pattern of performance that targeted specific tests rather than performing poorly across the entire test battery.
  
  
  
  Results contribute to a limited body of research investigating strategies utilized by individuals instructed to feign neurocognitive impairment. Findings signal the importance of developing additional embedded PVTs within standard cognitive tests to assess performance validity throughout a neuropsychological assessment. Future research should consider specifically targeting embedded measures in visual tests sensitive to slowed responding (e.g. response time).
authors.affiliation: a Department of Psychology , Wayne State University , Detroit MI , USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Kanser
authors.affiliation: a Department of Psychology , Wayne State University , Detroit MI , USA.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Rapport
authors.affiliation: a Department of Psychology , Wayne State University , Detroit MI , USA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Bashem
authors.affiliation: a Department of Psychology , Wayne State University , Detroit MI , USA.
authors.forename: Nia M
authors.initials: NM
authors.lastname: Billings
authors.affiliation: b School of Medicine , Wayne State University , Detroit, MI , USA.
authors.forename: Robin A
authors.initials: RA
authors.lastname: Hanks
authors.affiliation: c John D. Dingell Veterans Affairs Medical Center , Detroit, MI , USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Axelrod
authors.affiliation: a Department of Psychology , Wayne State University , Detroit MI , USA.|d Cleveland Clinic Lou Ruvo Center for Brain Health , Las Vegas, NV , USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000523:psychology*; D004522:Educational Status; D005260:Female; D006801:Humans; D007360:Intelligence; D008297:Male; D008306:Malingering / Q000175:diagnosis / Q000523:psychology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D016544:Patient Simulation; D011597:Psychomotor Performance; D011930:Reaction Time; D015203:Reproducibility of Results; D057566:Self Report; D055815:Young Adult
keywords: Assessment; malingering; performance validity; traumatic brain injury