Abstract

The Post-concussive Symptom Questionnaire (PCSQ) and its short forms were evaluated to determine their utility in measuring symptom validity as brief self-report measures in 112 individuals referred for a neuropsychological evaluation. First, the relationships between the PCSQ forms and measures of cognitive performance (Wechsler Adult Intelligence Scale-Fourth Edition Full-Scale IQ, California Verbal Learning Test-Second Edition Trials 1–5 Total T-score, Trails B, FAS), general distress (Minnesota Multiphasic Personality Inventory [MMPI]-2 M8), and self-report symptom validity (MMPI-2 FBS Symptom Validity Scale [FBS] and Response Bias Scale [RBS]) were investigated to determine construct validity. Measures of self-report symptom validity explained the greatest amount of variance. Second, receiver operating characteristics curve analyses were conducted to determine the predictive value of the PCSQ forms in detecting over reporting on the FBS and the RBS in addition to establishing optimal cutoff scores. On the basis of the proposed cutoff scores, sensitivity, specificity, positive predictive power, negative predictive power, and hit rates were calculated.

Introduction

It is increasingly clear that various types of symptom validity and cognitive effort measures are necessary to ensure a valid neuropsychological assessment. This point is highlighted by the evidence that cognitive effort and psychological symptom validity are distinct constructs from each other (Boone et al., 1995; Nelson, Sweet, Berry, Bryant, & Granacher, 2007; Ruocco et al., 2008). Therefore, effort and accuracy of responding may be sufficient in one domain, but simultaneously insufficient in the other, thus necessitating the thorough measurement of effort in both domains (Ruocco et al., 2008).

In order to adequately support the presence or the absence of sufficient effort and accuracy of reporting, neuropsychologists are encouraged to use multiple sources of data, such as initial injury severity, premorbid history, comorbid factors, forced-choice tests, floor effect methods, performance patterns, performance curve analysis, as well as validated self-report measures (cf. Millis & Volinsky, 2001; Slick, Sherman, & Iverson, 1999). However, the practice of including multiple forms of effort and symptom validity tests poses a practical challenge of maximizing the utility of the battery without burdening the examinee with extensive hours of testing. In an effort to address the balance between validity and practicality, the current article sought to evaluate the Post-concussive Symptom Questionnaire (PCSQ) as a relatively brief self-report measure of symptom validity by using validated neuropsychological and personality measures.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a well-validated and commonly used self-report measure used to evaluate physical and psychological symptoms and adjustment with the benefit of including validity scales to assess response style. Along with the standard validity scales, such as F, FB, FP, L, K, VRIN, and TRIN, the FBS Symptom Validity Scale (FBS; Lees-Haley, English, & Glenn, 1991) and the Response Bias Scale (RBS; Gervais, Ben-Porath, Wygant, & Green, 2007) were developed specifically to detect over reporting (OR) of symptoms and response bias on this measure of affect and personality. The FBS is composed of 44 items selected from the 567-item full-length MMPI-2 based on their content and frequency of endorsement by poor effort in personal injury litigants and infrequency of endorsement with individuals with “bona fide” injuries, resulting in a stereotyped “fake bad” response pattern (Lees-Haley et al., 1991). Further validation demonstrated that the FBS successfully discriminated between non-litigating individuals with verified traumatic brain injury and litigating individuals with mild traumatic brain injury (mTBI) who demonstrated poor effort with superior sensitivity and specificity to traditional MMPI-2 validity scales (Ross, Millis, Krukowski, Putnam, & Adams, 2004). Similarly, meta-analysis indicated that the FBS performed similar to or better than the standard MMPI-2 validity scales in discriminating between OR and comparison individuals with a weighted effect size of 0.96 (Nelson, Sweet, & Demakis, 2006).

Subsequently, the RBS was developed using multiple regression analyses to predict failure on the measures of cognitive effort, such as the Word Memory Test (Green & Astner, 1995; Green, 2003), Medical Symptom Validity Test (Green, 2004), Computerized Assessment of Response Bias (Allen, Conder, Green, & Cox, 1997), and the Test of Memory Malingering (TOMM; Tombaugh, 1996). Incidentally, the resulting 28 items of the RBS fell within the first 370 items of the MMPI-2, allowing the scale to be utilized when either the long or the short form is administered. The validation of this scale indicated that the RBS performed better than F, Fp, and FBS in predicting poor effort on the four cognitive symptom validity tests (Gervais et al., 2007). Further evaluation of the scale indicated that it was predictive of self-reported memory complaints, but was not related to a cognitive measure of verbal memory, suggesting that it measured OR of cognitive complaints and not true memory impairment (Gervais, Ben-Porath, Wygant, & Green, 2008).

Although the MMPI-2 scales of FBS and RBS discriminate between individuals with poor effort or OR response style from valid presentations, the length of the MMPI-2 may be somewhat prohibitive in some clinical settings, particularly if time is limited. Therefore, investigating the validity and utility of briefer self-report symptom validity measures is warranted. In particular, the 44-item PCSQ was developed originally by Lees-Haley (1992) to investigate the base rates of neuropsychological symptoms in litigating individuals and was repeated in comparing neuropsychological complaints in normal controls and in 170 personal injury claimants (Lees-Haley & Brown, 1993). In both studies, claimants endorsed a large number of neuropsychological symptoms, despite the exclusion of individuals filing neuropsychological impairment claims.

Tsanadis and colleagues (2008) investigated the PCSQ's ability to discriminate between individuals with a diagnosis of moderate to severe traumatic brain injury from individuals meeting criteria for at least probable malingering following mTBI. Interestingly, results indicated that individuals with mTBI endorsed significantly more symptoms in comparison with individuals with moderate to severe TBI. These findings support the potential utility of the PCSQ in differentiating between individuals with poor effort and those with adequate effort.

Briefer derivatives of the PCSQ have been constructed to measure symptom validity in reporting post-concussive symptoms. These include the PCS-19 (Millis, Hanks, Fichtenberg, & Axelrod, 2007) and the PCS-Negative Impression Management (PCS-NIM) Scale (Tsanadis et al., 2007). Millis and colleagues (2007) constructed the PCS-19 by conducting a Rasch analysis, which estimates the probabilities of item endorsement using the measure's total score. Nineteen items remained after redundant or poorly fitting items were removed. The authors noted that scores >11 should be examined for aberrant response patterns.

In constructing the PCS-NIM, Tsanadis and colleagues (2007) administered the PCSQ to individuals with moderate to severe TBI and to individuals with mTBI who had failed at least two validated cognitive effort tests. Using Fischer's exact test, items were selected that discriminated between the two groups with significance of .01 or below, resulting in 19 items. A receiver operating characteristics (ROC) curve analysis showed an area under the curve (AUC) of 0.79 with an optimal cutoff score of >13.

The current study aimed to investigate the utility of the PCSQ and its briefer derivatives (PCS-19 and PCS-NIM) by first determining construct validity and then evaluating its ability to predict response patterns as measured by well-validated self-report symptom validity measures. It was predicted that self-report symptom validity measures would explain the most variance in the PCSQ forms, whereas the measures of cognitive performance and effort would be distinct, considering cognitive effort and symptom over report have been found to be distinct constructs (Ruocco et al., 2008). Additionally, it was expected that the PCSQ forms would predict individuals classified as OR as determined by the FBS and the RBS.

Materials and Methods

Participants

Participants consisted of 112 consecutively evaluated individuals of which 95 met inclusion criteria. Included participants presented with mixed neurological (n = 71) and psychiatric (n = 24) referral questions at an urban Department of Veterans Affairs Medical Center. Neurological referral questions included traumatic brain injury (54%), mild cognitive impairment (13%), cerebrovascular disease (5%), multiple sclerosis (2%), and hypoxia (3%). Psychiatric referral questions included attention deficit-hyperactivity disorder (11%), anxiety (4%), somatization (4%), mood disorder (2%), learning disability (1%), and psychosis (1%). Referral sources consisted of a polytrauma clinic (47%), mental health clinic (21%), primary care clinics (16%), woman's clinic (5%), vocational rehabilitation (4%), neurology clinic (3%), and compensation and pension (3%). In short, 3 individuals were referred for evaluations to determine compensation and the remaining 92 individuals were referred for clinical treatment. The sample had a mean age of 38.7 (SD = 12.1), education of 13.4 (SD = 2.0), and Full-Scale IQ (FSIQ) from the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) of 96.7 (SD = 11.8). The sample was 92% men.

Measures

The cognitive assessment included WAIS-IV (The Psychological Corporation, 2008) FSIQ for general intellectual ability, California Verbal Learning Test-Second Edition (CVLT-II; Delis, Kramer, Kaplan, & Ober, 2000) Trials 1–5 Total T-score as an index of auditory verbal memory, Trail Making Test Part B (TMT-B; Heaton, Miller, Taylor, & Grant, 2004) for processing speed and cognitive flexibility, and Controlled Oral Word Association Test-FAS (COWA-FAS; Heaton et al., 2004) as a measure of participants' ability to categorize and access verbal information quickly. The Wide Range Achievement Test-Fourth Edition (WRAT-IV) Reading subtest was used to determine if the reading level was sufficient for self-administration of the MMPI-2.

The TOMM Trial 2 was used to assess the potential exaggeration of memory complaints through a forced-choice (FC) paradigm (Tombaugh, 1996). Similarly, the CVLT-II FC trial was used to evaluate cognitive effort, as Moore and Donders (2004; as cited in Sherman, Spreen, & Straus, 2006) found that the FC trial was equally sensitive to invalid test performance as the TOMM. Additionally, the WAIS-IV Reliable Digit Span (RDS) raw score was used as a measure of insufficient effort (The Psychological Corporation, 2009).

The MMPI-2 (Butcher, Dalstrom, Graham, Tellegen, & Kaemmer, 1989) was administered to evaluate emotional symptoms. The mean T-score of eight clinical scales (Hs, D, Hy, Pd, Pa, Pt, Sc, and Ma), also known as M8, was used as a measure of general distress. In a study comparing different MMPI-2 measures of general maladjustment, M8 was consistently the best predictor of maladjustment (Graham, Barthlow, Stein, Ben-Porath, & McNulty, 2002). In addition, scores of the FBS and the RBS were used as measures of self-report symptom validity. The 44-item PCSQ was administered to assess current psychological, cognitive, and somatic symptoms. The two shorter forms of the PCSQ (PCS-NIM and PCS-19) were derived from the results of the full PCSQ.

Procedure

As part of a complete neuropsychological evaluation, participants were administered the WAIS-IV, CVLT-II, Trails B, COWA-FAS, WRAT-IV, and TOMM according to the standardized procedures for each of the respective tasks. Additionally, all participants completed the PCSQ and MMPI-2.

Participants with WRAT Reading scores below the eighth grade level were excluded (n = 11) as recommended by the MMPI-2 publication manual (Butcher et al., 1989). From the MMPI-2, VRIN, TRIN, FBS scores, and RBS scores were calculated. Patients with VRIN or TRIN T-scores on the MMPI-2 higher than 80 were excluded from the sample (n = 6) leaving a total useable sample of 95 participants. Individuals with FBS scores <24 (n = 63) were classified as within normal limits (WNL), and individuals with scores of ≥24 (n = 32) were classified as OR. Additionally, individuals with RBS scores <12 (n = 46) were classified as WNL, and individuals with scores of ≥12 (n = 49) were classified as OR. Overall, 25 individuals were classified as OR on both the FBS and the RBS. The total scores of the PCSQ were calculated, in addition to the PCS-19 scores and the PCS-NIM scores.

Statistical Methods

The utility of the PCSQ and the two alternate forms was investigated with multiple regression analyses to determine the construct validity against other validated measures. ROC curve analyses were conducted to determine optimal cut scores of each PCSQ form. The cutoff scores were then evaluated for sensitivity, specificity, positive predictive power (PPP), negative predictive power (NPP), and hit rate based on the FBS and the RBS.

Results

Overall performance for the sample on cognitive and affective measures is presented in Table 1. As can be seen, intellectual skills fall in the average range, whereas performance on the measures of memory and executive functioning falls at a comparable level.

Table 1.

Mean scores on cognitive and affective measures

Measures M SD 
Cognitive performance 
 FSIQ 96.7 11.8 
 CVLT 45.3 11.2 
 Trails B 45.5 11.0 
 FAS 44.6 11.1 
Cognitive effort 
 RDS 9.4 2.2 
 FC 15.5 1.5 
 TOMM Trial 2 48.7 3.1 
Emotional distress 
 M8 68.6 11.2 
Symptom validity 
 FBS 20.7 5.8 
 RBS 11.8 4.2 
PCSQ 
 PCSQ Total 19.9 7.5 
 PCS-19 11.3 4.1 
 PCS-NIM 12.3 4.1 
Measures M SD 
Cognitive performance 
 FSIQ 96.7 11.8 
 CVLT 45.3 11.2 
 Trails B 45.5 11.0 
 FAS 44.6 11.1 
Cognitive effort 
 RDS 9.4 2.2 
 FC 15.5 1.5 
 TOMM Trial 2 48.7 3.1 
Emotional distress 
 M8 68.6 11.2 
Symptom validity 
 FBS 20.7 5.8 
 RBS 11.8 4.2 
PCSQ 
 PCSQ Total 19.9 7.5 
 PCS-19 11.3 4.1 
 PCS-NIM 12.3 4.1 

Notes: WAIS-IV = Wechsler Adult Intelligence Scale-Fourth Edition; FSIQ = WAIS-IV Full-Scale IQ; CVLT-II = California Verbal Learning Test-II; CVLT = CVLT-II Total Recall T-score; Trails B = Trail Making Test Part B T score; FAS = Controlled Oral Word Association Test-FAS T-score; RDS = WAIS-IV Reliable Digit Span raw score; FC = CVLT-II Forced Choice; TOMM trial 2 = Test of Memory Malingering Trial 2; M8 = Minnesota Multiphasic Personality Inventory-2 M8; FBS = FBS Symptom Validity Scale; RBS = Response Bias Scale; PCSQ = Post-concussive Symptom Questionnaire; NIM = Negative Impression Management.

Prior to evaluating the relationship of neuropsychological measures on the PCSQ Total, PCS-19, and PCS-NIM, individuals with RDS raw scores of 7 or lower (n = 7), CVLT-II FC raw scores of 14 or lower (n = 7), and individuals with TOMM Trial 2 raw scores of 45 or lower (n = 6) were identified as failing one (n = 4), two (n = 5), or three (n = 2) of the cognitive effort measures. With these 11 individuals removed to control for cognitive effort, regression analyses evaluated the relationship of neuropsychological measures (WAIS-IV FSIQ, CVLT-II Trials 1–5 T-score, Trails B T-score, and FAS T-score) to the PCSQ Total, PCS-19, and PCS-NIM. The findings consistently demonstrated that true cognitive impairment does not account for significant variance in any of the three versions of the PCSQ. The total variance accounted for by this model was 2% for PCSQ Total, 4% for PCS-19, and 2% for PCS-NIM.

Then, hierarchical multiple regression analyses evaluating emotion and PCS were evaluated using PCSQ Total, PCS-19, and PCS-NIM as criteria. Measures of symptom validity (FBS and RBS) were added in the first step, whereas general distress as determined by MMPI-2 M8 was added in the second step. The total variance accounted for in the first step was 42% in the PCSQ Total, 43% in the PCS-19, and 43% in the PCS-NIM. The measure of general emotional distress accounted for a minimal change in variance explained (Table 2).

Table 2.

Regression of symptom validity and general emotional distress measures on PCSQ scales

 PCSQ Total
 
PCS-19
 
PCS-NIM
 
 B SE β r2 r2Δ B SE β r2 r2Δ B SE β r2 r2Δ 
Step 1: SVM 
 FBS 0.50 0.13 0.38 .42** .42** .26 .07 .36 .43** .43** .26 .07 .36 .37** .37** 
 RBS 0.60 0.18 0.34 .37 .10 .37 .31 .10 .32 
Step 2: SVM and Distress 
 FBS 0.34 0.14 0.26 .45** .04* .15 .07 .22 .48** .05* .14 .08 .20 .43** .07* 
 RBS 0.36 0.20 0.20 .20 .11 .21 .13 .11 .13 
 M8 0.20 0.08 0.30 .13 .04 .36 .15 .05 .41 
 PCSQ Total
 
PCS-19
 
PCS-NIM
 
 B SE β r2 r2Δ B SE β r2 r2Δ B SE β r2 r2Δ 
Step 1: SVM 
 FBS 0.50 0.13 0.38 .42** .42** .26 .07 .36 .43** .43** .26 .07 .36 .37** .37** 
 RBS 0.60 0.18 0.34 .37 .10 .37 .31 .10 .32 
Step 2: SVM and Distress 
 FBS 0.34 0.14 0.26 .45** .04* .15 .07 .22 .48** .05* .14 .08 .20 .43** .07* 
 RBS 0.36 0.20 0.20 .20 .11 .21 .13 .11 .13 
 M8 0.20 0.08 0.30 .13 .04 .36 .15 .05 .41 

Notes: PCSQ = Post-concussive Symptom Questionnaire; SVM = Symptom Validity Measures; NIM = Negative Impression Management; FBS = FBS Symptom Validity Scale; RBS = Response Bias Scale; M8 = Minnesota Multiphasic Personality Inventory-2 M8.

*p < .05, **p < .001.

Recognizing that symptom validity scores were the most associated with PCSQ performance, we elected to determine the appropriate cutoff scores for the sample. ROC curve analyses were conducted to assess how well each of the three PCSQ indices discriminated between individuals who were classified as OR on both the FBS and the RBS and those who were not. Optimal cutoff scores were determined from the coordinates of the ROC curves with the formula (Sensitivity − Specificity)/(Sensitivity + Specificity) with values closest to zero suggesting maximum balance of sensitivity and specificity. High specificity cutoff scores were selected from coordinates with specificity above 90% and highest possible sensitivity. The results appear in Table 3.

Table 3.

Classification of symptom over report on PCSQ indices

 PCSQ Total
 
PCS-19
 
PCS-NIM
 
 >22 >27 >12 >15 >14 >16 
Specificity 77.1 94.3 74.3 91.4 78.6 91.4 
Sensitivity 80.0 36.0 76.0 36.0 76.0 28.0 
PPP 55.6 69.2 51.4 60.0 55.9 53.8 
NPP 91.5 80.5 89.7 80.0 90.2 78.0 
Hit Rate 77.9 78.9 74.7 76.8 77.9 74.7 
 PCSQ Total
 
PCS-19
 
PCS-NIM
 
 >22 >27 >12 >15 >14 >16 
Specificity 77.1 94.3 74.3 91.4 78.6 91.4 
Sensitivity 80.0 36.0 76.0 36.0 76.0 28.0 
PPP 55.6 69.2 51.4 60.0 55.9 53.8 
NPP 91.5 80.5 89.7 80.0 90.2 78.0 
Hit Rate 77.9 78.9 74.7 76.8 77.9 74.7 

Notes: PCSQ = Post-concussive Symptom Questionnaire; PPP = positive predictive power; NPP = negative predictive power; NIM = Negative Impression Management; Classification based on both FBS > 23 and RBS > 11; for each measure, first cutoff is for optimal classification, second cutoff is for high specificity.

In predicting group membership with combined over report on FBS and RBS, PCSQ Total achieved an AUC of 0.85 with optimal sensitivity and specificity cutoff of >22 and high specificity cutoff of >27, the PCS-19 achieved AUC of 0.86 with optimal cutoff of >12 and high specificity cutoff of >15, and the PCS-NIM achieved AUC of 0.84 with optimal cutoff of >14 and high specificity cutoff of >16. Using these cutoff scores, sensitivity, specificity, PPP, NPP, and hit rate were calculated for each of the indices based on group membership.

Discussion

The purpose of this study was to investigate the utility of the PCSQ and its short forms (PCS-19 and PCS-NIM) as brief self-report symptom validity measures. In multiple regression analyses, cognitive performance did not predict significant variance in the PCSQ, PCS-19, or PCS-NIM. This suggests that the PCSQ, PCS-19, and PCS-NIM all measure variance that is distinct from cognitive performance, which supports our prediction. Additionally, the results suggest that intellectual ability does not affect response style on the PCSQ measures.

Self-report symptom validity scales predicted significant variance in PCSQ Total score, PCS-19, and PCS-NIM. Overall emotional distress explained a relatively small amount of additional variance. These data support convergent validity of other self-report symptom validity measures with the PCSQ forms.

In a ROC curve analysis differentiating between response patterns (i.e., WNL and OR) on the both the FBS and the RBS, the PCS-19 demonstrated the highest AUC (0.86), followed closely by the PCSQ Total (0.85), and finally the PCS-NIM (0.84). The PCSQ Total with a cutoff score of >27 produced the highest specificity (94.3) as well as the best hit rate (78.9). However, similar classification rates between indices indicated that no one index stands out as superior, suggesting that the short forms perform well in comparison to the PCSQ Total with the benefit of having 19 items in comparison with 44. It should be noted that using the cutoff scores for optimal specificity in turn reduces sensitivity, which is to be expected. Overall, the study provides promising evidence that the PCSQ and its short forms perform well as brief measures of self-report symptom validity.

A limitation of the study is the lack of multiple methods of measuring both cognitive and emotional domains. Specifically, cognitive effort and performance were measured only with neuropsychological assessment measures, whereas symptom validity and general distress were measured with only self-report measures. Because of this, we are unable to discard the possibility of shared-methods variance affecting the results. However, the small increase in variance explained in the PCSQ measures by the self-report-based MMPI-2 M8 when added to a regression model including the FBS and the RBS does suggest that the findings are not spurious. Another potential limitation is that, aside from the three participants who were explicitly seeking compensation, it was unknown if the individuals referred for clinical purposes had intentions to seek compensation in the future, thus influencing their response styles. However, this limitation is common as intentions are difficult to assess. Furthermore, it is difficult to discern the generalizability of the findings, considering the exclusively military veteran sample. Replication studies utilizing other samples should be conducted to determine if the findings of the current study are applicable to the general population.

Funding

This work was supported by the Department of Veterans Affairs Predoctoral Associated Health Rehabilitation Research Fellowship Program.

Conflict of Interest

None declared.

References

Allen
L.
Conder
R. L.
Green
P.
Cox
D. R.
CARB 97' manual for the computerized assessment of response bias
 , 
1997
Durham, NC
CogniSyst
Boone
K. B.
Savodnik
I.
Ghaffarian
S.
Lee
A.
Freeman
D.
Berman
N. G.
Rey 15-item memorization and dot counting scores in a “stress” claim worker's compensation population: Relationship to personality (MCMI) scores
Journal of Clinical Psychology
 , 
1995
, vol. 
51
 
3
(pg. 
457
-
463
)
Butcher
J. N.
Dalstrom
W. G.
Graham
J. R.
Tellegen
A.
Kaemmer
B.
Manual for the administration and scoring of the MMPI-2
 , 
1989
Minneapolis
University of Minnesota Press
Delis
D. C.
Kramer
J. H.
Kaplan
E.
Ober
B. A.
California Verbal Learning Test-Second Edition, Adult Version.
 , 
2000
San Antonio, TX
The Psychological Corporation
Gervais
R. O.
Ben-Porath
Y. S.
Wygant
D. B.
Green
P.
Development and validation of a Response Bias Scale (RBS) for the MMPI-2
Assessment
 , 
2007
, vol. 
14
 
2
(pg. 
196
-
208
)
Gervais
R. O.
Ben-Porath
Y. S.
Wygant
D. B.
Green
P.
Differential sensitivity of the Response Bias Scale (RBS) and the MMPI-2 validity scales to memory complaints
The Clinical Neuropsychologist
 , 
2008
, vol. 
22
 (pg. 
1061
-
1079
)
Graham
J. R.
Barthlow
D. L.
Stein
L. A. R.
Ben-Porath
Y. S.
McNulty
J. L.
Assessing general maladjustment with the MMPI-2
Journal of Personality Assessment
 , 
2002
, vol. 
78
 
2
(pg. 
334
-
347
)
Green
P.
Astner
K.
Manual for the oral word memory test
 , 
1995
Edmonton, Canada
Neurobehavioral Associates
Green
P.
Green's Word Memory Test for Windows: User's manual
 , 
2003
Edmonton, Canada
Green's Publishing
Green
P.
Green's Medical Symptom Validity Test (MSVT): User's manual
 , 
2004
Edmonton, Canada
Green's Publishing
Heaton
R. K.
Miller
S. W.
Taylor
M. J.
Grant
I.
Revised Comprehensive Norms for an Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological Norms for African American and Caucasian Adults
 , 
2004
Lutz, FL
Psychological Assessment Resources, Inc
Lees-Haley
P. R.
Neuropsychological complaint base rates of personal injury claimants
Forensic Reports
 , 
1992
, vol. 
5
 (pg. 
385
-
391
)
Lees-Haley
P. R.
Brown
R. S.
Neuropsychological complaint base rates of 170 personal injury claimants
Archives of Clinical Neuropsychology
 , 
1993
, vol. 
8
 (pg. 
203
-
209
)
Lees-Haley
P. R.
English
L. T.
Glenn
W. J.
A Fake Bad Scale on the MMPI-2 for personal injury claimants
Psychological Reports
 , 
1991
, vol. 
68
 (pg. 
203
-
210
)
Millis
S. R.
Hanks
R. A.
Fichtenberg
N. L.
Axelrod
B. N.
Rasch Analysis of the PCSQ: Measuring the Core Construct of Head Injury Symptomatology
 , 
2007
Poster session presented at the International Neuropsychological Society 35th Annual Meeting
Portland, Oregon
Millis
S. R.
Volinsky
C. T.
Assessment of response bias in mild head injury: Beyond malingering tests
Journal of Clinical and Experimental Neuropsychology
 , 
2001
, vol. 
23
 
6
(pg. 
809
-
828
)
Moore
B. A.
Donders
J.
Predictors of invalid neuropsychological test performance after traumatic brain injury
Brain Injury
 , 
2004
, vol. 
18
 (pg. 
975
-
984
)
Nelson
N. W.
Sweet
J. J.
Berry
D.
Bryant
F. B.
Granacher
R. P.
Response validity in forensic neuropsychology: Exploratory factor analytic evidence of distinct cognitive and psychological constructs
Journal of the International Neuropsychological Society
 , 
2007
, vol. 
13
 (pg. 
440
-
449
)
Nelson
N. W.
Sweet
J. J.
Demakis
G. J.
Meta-analysis of the MMPI-2 Fake Bad Scale: Utility in forensic practice
The Clinical Neuropsychologist
 , 
2006
, vol. 
20
 
1
(pg. 
39
-
58
)
Ross
S. R.
Millis
S. R.
Krukowski
R. A.
Putnam
S. H.
Adams
K. M.
Detecting incomplete effort on the MMPI-2: An examination of the Fake Bad Scale in mild head injury
Journal of Clinical and Experimental Neuropsychology
 , 
2004
, vol. 
26
 
1
(pg. 
115
-
124
)
Ruocco
A. C.
Swirsky-Sacchetti
T.
Chute
D. L.
Mandel
S.
Platek
S. M.
Zillmer
E. A.
Distinguishing between neuropsychological malingering and exaggerated psychiatric symptoms in a neuropsychological setting
The Clinical Neuropsychologist
 , 
2008
, vol. 
22
 (pg. 
547
-
564
)
Slick
D. J.
Sherman
E. M.
Iverson
G. L.
Diagnostic criteria for malingered neurocognitive dysfunction: Proposed standards for clinical practice and research
The Clinical Neuropsychologist
 , 
1999
, vol. 
13
 (pg. 
545
-
561
)
Strauss
E.
Sherman
E.
Spreen
O.
A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary
 , 
2006
Oxford
Oxford University Press
The Psychological Corporation.
Wechsler Adult Intelligence Scale, Fourth Edition manual
 , 
2008
San Antonio, TX
Author
The Psychological Corporation.
Advanced clinical solutions for WAIS-IV and WMS-IV administration and scoring manual
 , 
2009
San Antonio, TX
Author
Tombaugh
T. N.
Test of Memory Malingering
 , 
1996
Toronto, Canada
MultiHealth Systems
Tsanadis
J.
Montoya
E.
Hanks
R. A.
Millis
S. R.
Fichtenberg
N. L.
Axelrod
B. N.
Brain injury severity, litigation status, and self-report of postconcussive symptoms
The Clinical Neuropsychologist
 , 
2008
, vol. 
22
 (pg. 
1080
-
1092
)
Tsanadis
J.
Montoya
E.
Millis
S. R.
Hanks
R. A.
Fichtenberg
N. L.
Axelrod
B. N.
A Negative Impression Management Scale for the Postconcussive Syndrome Questionnaire
 , 
2007
Poster session presented at the International Neuropsychological Society 35th Annual Meeting
Portland, Oregon