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Suboptimal Performance: When Do Methods & Mood Matter?

Suboptimal Performance: When Do Methods & Mood Matter?. Martin L. Rohling, Ph.D. University of South Alabama. Definition of “Education”. “Education is the process of going from cocksure ignorance to thoughtful uncertainty” (Source Unknown). Study 1: Reference.

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Suboptimal Performance: When Do Methods & Mood Matter?

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  1. Suboptimal Performance:When Do Methods & Mood Matter? Martin L. Rohling, Ph.D. University of South Alabama

  2. Definition of “Education” “Education is the process of going from cocksure ignorance to thoughtful uncertainty” (Source Unknown)

  3. Study 1: Reference Rohling, M. L., Green, P., Allen, L. M., & Williamson, D. J. (2000). Comparisons between a Logistic Regression Formula for the CVLT and the Word Memory Test as Indicators of Suboptimal Performance in a Sample of Litigants. Poster presented at the 20th annual convention of NAN in Orlando, FL.

  4. California Verbal Learning Test • Original version of verbal learning and memory task (Delis et al., 1987) • 16-item list learning task • dependent measures used • immediate FR • 20 min. DFR • recognition memory • Sensitive to neurological disease (e.g., Delis et al., 1991, Deweer et al., 1994), age (Kausler, 1994), and gender (Wiens et al., 1994)

  5. Study 1: Specific Questions • Within a compensation-seeking sample • Do the WMT and the CVLT-Logit Formula of Millis (1999) identify the same patients as exerting suboptimal effort? • If not, how do the identified groups differ on • Tests of neurocognitive abilities • Self-report of memory functioning • Other tests that have been cross-validated and found to be sensitive to suboptimal effort

  6. Study 1: Participants • 794 patients referred for evaluation for compensation-related purposes • All diagnostic groups included • 53% Head injury referral • 27% Medical referrals • 12% Psychiatric referrals • 8% Other neurological • Age = 42 (11); Education = 12 (4); Sex = 63% males; Non-Native English = 14%; Handedness = 9% Left

  7. Study 1: Effort Groups • WMT: Invalid if any of the 3 criteria violated • IR < 82.5% • DR < 82.5% • CON1 < 75% • CVLT-Logit Formula: Invalid if the Logistic equation, (e^g) / [1 + (e^g)], is less than .50 • the constant g is defined as follows: g = 8.41 + (SDFR * .56) - (LDFR * .52) - (RG Hits * .72)

  8. 523 (66%) 59 (7%) 112 (14%) 100 (13%) Study 1: WMT & CVLT-Logit Identify Different Patients as Exaggerating OVERALL SAMPLE CVLT Genuine Exaggerating WMT 582 (73%) Genuine Exaggerating 212 (27%) 635 (80%) 159 (20%)

  9. Study 1: WMT & CVLT-Logit Identify Different Patients as Exaggerating • Relative to the WMT: • CVLT identified 25% fewer exaggerators • CVLT identified 9% more genuine patients • 79% overall agreement • However, for patients identified by one or the other method (n = 271) • methods agreed just 37% of the time

  10. Study 1: Patients Identified as Exaggerating Differed by Method Demographic Differences Relative to WMT-poor effort group: • CVLT-Logit group was older • CVLT-Logit group less educated • CVLT-Logit group had more patients whose 1st language was not English

  11. Graphic’s Abbreviations G-W Genuine WMT - ABOVE cut score G-C Genuine CVLT - ABOVE cut score E-W Exaggerated WMT - BELOW cut score E-C Exaggerated CVLT - BELOW cut score Composite Summary Scores MCI Memory Complaints Inventory NPT Neuropsychological Tests EPT Emotional & Personality Tests

  12. Differences on Summary Measures

  13. Examples on Specific NPTs

  14. Gervais’ & Green’s SamplesSummary Measure Similarities

  15. Green’s & Gervais’ Samples

  16. Study 1: Conclusions • Measures identified different patients • Findings replicated in independent sample • Compared to the CVLT, the WMT groups had larger differences on • Measures sensitive to symptom exaggeration (i.e., RCFT, Warr-F) • Other validated SVTs (e.g., CARB) • Self-reports of memory & emotional functioning (i.e., MCI & MMPI-2)

  17. Study 1: Why Did Results Differ? • WMT less confounded by Age & Education • CVLT sensitive to cognitive impairment • works against it as a SVT • However, • CVLT congruence with WMT (79%) • CT algorithms (64% to 73%)

  18. Study 2: Reference Rohling, M. L., Green, P., Allen, L. M., & Iverson, G. L. (2002). Depressive symptoms and neurocognitive test scores in patients passing symptom validity tests. Archives of Clinical Neuropsychology, 17, 205-222.

  19. Study 2: Specific Questions • Within an optimally performing compensation-seeking sample • Memory Complaints correlate with mood • Depressed mood impairs cognition • Memory Complaints unrelated to cognition

  20. Study 2: Depression Measures 3 measures of mood • Beck Depression Inventory • MMPI-2 Depression scale • r = .70 with BDI • SCL-90-R Depression scale • r = .74 with BDI • r = .63 MMPI-De

  21. Study 2: Mood Group Assignment • Patients classified into 2 subgroups • From entire sample, 420 passed all SVTs • Sample split based on BDI • Low-Depressed 25%ile on BDI (< 10) • n = 178, M = 6 (3) • High-Depressed 75%ile on BDI (> 25) • n = 187, M = 31 (6)

  22. Study 2: Participants • All 365 patients referred for evaluation for compensation-related purposes • All diagnostic groups included • 53% Head injury referrals • 22% Medical referrals • 14% Psychiatric referrals • 11% Other neurological • Age = 42 (11); Education = 13 (3); Sex = 64% males; Non-Native English = 18%; Handedness = 9% Left

  23. Study 2: ResultsMood & Validity Status SVT Status Genuine Exaggerating Mood BDI 175 (48%) Depress 75%ile 186 (52%) Non-Dep 25%ile 266 (74%) 95 (26%)

  24. EPT MCI OTBM EPT MCI OTBM EPT MCI OTBM 1.3 1.3 1.1 1.1 Low-Dep Low-Dep Low-Dep .9 .9 .7 .7 .5 .5 .3 .3 .1 .1 Z-scores -.1 -.1 -.3 -.3 -.5 -.5 -.7 -.7 -.9 -.9 -1.1 -1.1 High-Dep High-Dep High-Dep -1.3 -1.3 -1.5 -1.5 Total Sample Genuine Pts Exaggerating Pts Study 2: ResultsSample Split by Validity Status

  25. Study 2: Results Effect of Mood Depends on Effort • Exaggerating patients accounted for • 39% of High-Dep group • 14% of Low-Dep group • Mood & Effort used as IVs and Cognition DV • effect for Effort, no effect for Mood • However, when Memory Complaints DV • effects for both Effort and Mood • Also, when other Emotion/Personality DV • effects for both Effort and Mood

  26. Study 2: Answers to Specific Questions When both mood groups were included in regression analysis, as predicted • Memory ratings related to mood • (r = .60; p < .0001) • Mood not correlated with cognition • (r = .10; p > .10) • Memory ratings not related to cognition • (r = .13, p = .06)

  27. Study 2: Mood Replication Gervais’ pain sample findings (n = 177) • Exaggerating patients accounted for • 55% of High-Dep; 33% of Low-Dep group • Memory ratings related to mood (r = .55) • Mood not correlated with cognition (r = .06) • Memory ratings related to cognition (r = .15) • Group means correlated with Green’s .94 • all patient (High-D, Low-D, Gen, & Exag).

  28. Study 2: Conclusions • Memory complaints not synonymous with impairment in compensation seeking sample • Findings replicated • Effort accounts for more variance in self-ratings of cognition and objective performance than mood • Findings replicated

  29. Study 1 & 2: Summary • Ability test algorithms less effective for the assessment of effort than tests designed for this purpose • In a compensation-seeking sample • Mood not related to cognitive impairment • Mood is related to memory complaints • More variance accounted for by Effort than by Mood

  30. Genuine (n = 412) Exaggerating (n = 149) Dependent Domain Normal (n = 311) Neuro (n=101) Normal (n = 144) Neuro (n = 5) Neuropsychological Tests .33 (.62) .19 (.64) -.60a, b (.80) -.79a, b (.65) Symptom Validity Tests .51 (.38) .50 (.30) -1.25a, b (.94) -.50a, b, c (.52) Memory Complaints Inv. .14 (.93) .41a (.92) -.62a, b (.93) .49c (.54) Psychiatric Symptoms .10 (.95) .46a (.96) -.39a, b (.85) .19 (.99)

  31. Gen (n=412) Ex (n=149) ES Cognitive Domain M SD M SD t p (d) Neuropsych Ability .34 .75 -.86 1.01 15.3 .0001 1.43 Attention/Work Mem .29 .76 -.74 1.13 12.0 .0001 1.16 Visual Mem Learn .28 .85 -.72 .99 11.8 .0001 1.12 Perceptual Organ .27 .79 -.68 1.15 11.1 .0001 1.05 Auditory Mem Learn .23 .88 -.60 1.04 9.5 .0001 .89 Executive Function .23 .88 -.60 1.04 9.5 .0001 .89 Verbal Comprehen .18 .92 -.45 1.06 7.0 .0001 .65 Psychomotor Speed .17 .80 -.41 1.29 6.1 .0001 .60

  32. .5 .3 .1 -.1 Gen-Norm -.3 Gen-Neuro Cell Mean -.5 Exag-Norm Exag-Neuro -.7 -.9 -1.1 -1.3 -1.5 Neuropsych Ability Symptom Validity

  33. .5 .3 .1 -.1 Gen-Norm -.3 Gen-Neuro Cell Mean Exag-Norm -.5 Exag-Neuro -.7 -.9 -1.1 -1.3 -1.5 Memory Complaints Psychiatric Symptoms

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