Although there are excellent books on the topic of neuropsychological validity testing and malingering already available (e.g., Boone, 2007; Larrabee, 2007; Morgan & Sweet, 2009), none have been specifically devoted to the integration of symptom/performance validity with patients who have sustained mild traumatic brain injuries (mTBI). Carone and Bush's book focuses on this subspecialty by providing 19 well-written chapters that are authored by experts in the field of neuropsychological validity assessment and malingering.
Chapter 1 introduces the book by providing a brief history of brain injury and malingering. Current trends are also reviewed, which clearly show the reader that neuropsychology has a prominent role in the assessment of both mTBI and malingering.
In chapter 2, the author reviews and critiques previously proposed methods and models for identifying malingering via clinical judgment. He also cites literature on the efficacy of clinical judgment for detecting invalid neuropsychological test results. I found this to be an excellent chapter with clinically applicable topics that other books frequently do not discuss in this great of detail.
Chapter 3 is a basic review of ethical considerations in neuropsychology. Although well written and informative, other books (i.e., Larrabee, 2012; Morgan & Sweet, 2009) discuss ethical considerations in forensic neuropsychology in as much or more detail.
Chapter 4 is an interesting read for multiple reasons. The chapter begins with a brief discussion of primary gains, secondary gains, and secondary losses. The authors (Slick and Sherman) then write in detail about their numerous proposed updates and modifications to Slick, Sherman, and Iverson's (1999) malingered neurocognitive dysfunction criteria. Finally, the authors review differential diagnosis of malingering and other commonly known (e.g., conversion disorder, factitious disorder), less commonly known (e.g., cogniform disorder, neurocognitive hypochondriasis), and newly proposed (e.g., secondary malingering, adjustment disorder with specious symptoms) conditions.
Chapter 5 is on the topic of providing explanations for noncredible test findings. The authors note that some providers are hesitant or unwilling to diagnose malingering, so, instead, they attribute noncredible findings to factors such as anxiety, depression, fatigue, and pain. The authors review the literature and provide multiple reasons as to why many of these factors are unlikely to cause validity test failures.
Chapter 6 is on two different, but often times overlapping, topics. The authors discuss their previously proposed model of approaching feedback sessions with patients regarding invalid test performances (Carone, Iverson, & Bush, 2010). Next, the authors discuss common issues that arise during feedback sessions with patients who report long-term cognitive symptoms following mTBI. This is an excellent chapter detailing clinically applicable methods of addressing potentially difficult issues related to both test invalidity and mTBI.
Chapter 7 focuses on research related to mTBI assessment and validity testing. The authors first review some of the major mTBI literature findings, including diagnostic schemes, expected course, chronic symptom presentation, and factors that complicate recovery. Next, they briefly discuss common approaches to validity testing research with mTBI samples, and then they review general findings from mTBI/noncredible symptom presentation literature.
Chapters 8, 9, and 10 are on the respective topics of freestanding, embedded, and psychological validity indices for use in mTBI cases. Although chapters 8 and 10 are well written and germane to the topic, they seem to be rather brief and focused reviews, and I would direct interested readers to other texts (i.e., Boone, 2007). Chapter 9, however, is more comprehensive. It starts by providing reasons an examiner might choose to utilize embedded validity measures. The authors also briefly review commonly used methods to develop and validate (e.g., floor effects, criterion variable designs) embedded validity indices. Finally, the authors discuss the uses, strengths, and weaknesses of multiple diagnostic classification statistics (in some ways akin to chapters in Larrabee, 2007) in evaluating and combining embedded validity findings. These authors do an excellent job at discussing potentially confusing statistical analyses in simple terms.
Chapter 11 provides strategies for non-neuropsychologists to identify noncredible symptoms after mTBI. The various strategies include a coherence analysis via record reviews, cognitive validity tests designed for physician use, neuromedical indicators of symptom invalidity, and self-report inventories. As the chapter title implies, this chapter is one of the few that will not be directly applicable to some neuropsychologists' clinical practices.
Chapters 12 and 13 provide literature reviews of validity tests in the domains of (i) attention, processing speed, language, and visuospatial/perceptual function and (ii) sensory, motor, and executive function, respectively. The authors do a good job at covering multiple validity measures (most being embedded) and reporting cutoffs, sensitivity rates, and specificity rates in mTBI samples. These chapters are similar to many chapters that you will find in Boone's (2007) book.
Chapter 14 is an interesting read that is on the topic of functional neuroimaging studies of deception and malingering. The author details the few studies that have evaluated the neuroanatomical correlates of general deception, feigned memory impairment, and forced-choice validity testing.
Chapters 15 and 19 summarize the literature on performance validity testing in specific clinical samples. Chapter 15 emphasizes validity testing in adult mTBI, chronic pain, and PTSD samples. Chapter 19 emphasizes validity testing in pediatric mTBI, older adults (primarily those with dementia), patients with “other neurological impairment,” and patients with psychiatric conditions. Although sections of these chapters, such as the adult and pediatric mTBI sections, are well written and informative, other sections are extremely brief and seem out of place given the emphasis of the book (i.e., mTBI).
Finally, chapters 16, 17, and 18 are on the topics of mTBI validity assessment in (i) disability/litigation contexts, (ii) the sports concussion realm, and (iii) military and veteran populations, respectively. Although these three domains are rather broad, the authors do outstanding jobs of providing the major and pertinent findings from within these fields. These chapters would be excellent starting points for clinicians wanting to learn more about testing in these specific clinical contexts.
Overall, this book has strengths and weaknesses but the strengths easily outweigh the weaknesses. The book is well written, engaging, and easy to read. It goes well beyond simply reviewing validity test literature, as numerous clinical issues related to both mTBI and validity testing are discussed, validity assessment in multiple clinical and forensic settings is described, and up-to-date research findings are provided. I would recommend this book to any clinician (or clinician in training) who wants a practical guide specifically devoted to integrating validity assessment techniques and outcomes into clinical work.