I have a confession to make. When I passed by this volume on a book display at a research conference, my first thought was, “Another casebook. On malingering. Gee, I see cases involving this issue day in and day out in my clinical practice and in my research. What would I learn from reading more malingering cases?” When I was invited to write a review of the book, I decided to give it a critical look and was humbled by the immense value of well-written clinical cases, such as those presented in Morgan and Sweet's edited book.
The book provides valuable coverage, in case the presentation form, of the difficult conceptualization and assessment issues that arise when a neuropsychologist encounters probable invalid performance. Morgan and Sweet gathered together a series of experts well-grounded in the substantial science of malingering detection; in fact, some of them are heavy hitters in the malingering research realm. But the experts also apply that science and help the reader explore professional, legal, and ethical complexities in application of malingering research to clinical practice.
Section 1 includes three non-case-based chapters focused on foundational issues in the use of measures of invalidity in neuropsychological assessment, such as the contexts in which invalid responding may be considered, the professional necessity of malingering assessment in neuropsychological evaluations, and statistical issues that underlie decision-making (a particularly valuable summary of the most important statistical decision rules every clinical neuropsychologist should read).
Section 2, by far the largest of the book, presents a multitude of civil litigation cases in which the authors explore a specific case, including the case history, relevant behavioral observations, and neuropsychological evaluation results and provide a window into their reasons for conceptualizing the cases as they did, many times citing scientific literature to support their interpretations. The cases represent a variety of assessment contexts and sometimes provide an historical perspective that illustrates changes in malingering conceptualization due to advances in the research literature. Referral issues include TBI at all levels of severity, psychiatric presentations, health and medical presentations, toxic exposures, and pediatric/developmental disorders. These cases serve as illustration of invalid presentation of both cognitive, psychiatric, and health/medical symptoms, as well as consideration of the complexity of diagnosis in such presentations. Because many chapters present cases in which repeated assessments occurred, they are also useful in seeing data across other evaluative settings, interpreted by other professionals who typically did not consider the potential for invalid performance to influence results and interpretation of those findings, and then re-conceptualized together with new evaluation data by the chapter author. Occasionally, the chapters also include outcome after the case was closed, which is often information neuropsychologists are not privy to outside of a litigation context.
Section 3 presents four cases from criminal litigation, including coverage of competency to stand trial, sanity, and competency issues, whereas Section 4 provides perspectives on the use of invalidity assessments in multiple settings, such as disability insurance (perspectives from the insurance company, an external consultant, and an attorney representing the claimant), social security adjudication, and the setting of plaintiff and defense attorneys in both personal injury and criminal court cases. Seeing the viewpoints on use of malingering tests of those who do most of their work while wearing a particular professional lens is most illuminating.
Section 5 provides discussion of ethical and professional issues in the use of invalidity assessments in neuropsychological practice. Although this section may seem brief (two chapters), it should be noted that these issues are embedded in many of the cases throughout the book. The final section provides two chapters that present the cogent arguments for use of invalidity measures in clinical practice and also head the reader in future research directions, which the cases helped to elucidate: what more do we still need to know?
Although the above summary highlights the content value of this text, there are three other important values of the book to consider. Many of the cases present similar issues, which highlights the critical importance of assessing for valid presentation as a part of neuropsychological evaluation across many contexts. However, the authors sometimes take slightly different perspectives on the same issues, which only serve as a good illustration of how complex these issues can be in actual clinical practice. The differing perspectives provide fodder for the individual reader to carefully consider how they would approach the same issue in their practice, and also as excellent discussion points if the text were used in a didactic setting.
Finally, the text has five appendices, which provide a forensic bibliography complied by Sweet, covering some of the major studies in the use of standalone invalidity measures, neuropsychological and psychological measures that are also useful in malingering detection, a compilation of other articles relevant to malingering, and additional professional and ethical topics about specific populations, evidentiary rulings, and professional practice issues not otherwise covered in the text. These appendices provide a noncomprehensive but valuable resource for both clinician and researcher.
Overall, I highly recommend this book. The case study approach returns us to our clinical neuropsychology roots, recognizing the value of a unique case to illustrate important issues for both science and clinical practice, and the cases are grounded in the existing research when those issues are tackled, while still representing the complexity of applying our scientific knowledge in a clinical setting. As a didactic text, I would find the book most useful for advanced graduate student or internship/postdoctoral training, as the cases can be most fully appreciated by those who already possess a fundamental grounding in neuropsychology in general, as well as some basic clinical and research knowledge in the use of malingering tests. However, the text is also of a great value to practicing neuropsychologists and to those who conduct research in this area. Although it is worth noting that this text, as part of the AACN continuing education series, offers the reader online CE credits for reading it and completing an exam about it, the book is a worthy read even without that added bonus.