Assessment XX(X) 1 –10

During the past 10 to 15 years, research on the topic of neurocognitive symptom validity testing (SVT) has vastly expanded (Larrabee, 2003; Whitney, Davis, Shepard, Ber-tram, & Adams, 2009). This expansion is likely due, in part, to neuropsychologists ’ growing awareness of three find-ings. First, neuropsychologists are unable to reliably dis-criminate between individuals who are providing suspect effort and individuals who are providing adequate effort based solely on general neuropsychological test data (Heaton, Smith, Lehman, & Vogt, 1978), self-reported symptoms (Lees-Haley & Brown, 1993), or clinical judgment (Millis & Putnam, 1996). Second, patient effort on testing accounts for a substantial amount of variance in neuropsychological test performance, with some studies indicating that it might account for as much as 50 % of the variance in forensic set-tings (Constantinou, Bauer, Ashendorf, Fisher, & McCaf-frey, 2005; Green, Rohling, Lees-Haley, & Allen, 2001). Third, base rates of malingering during neuropsychological evaluations are substantially higher than previously believed, even in nonforensic settings (Boone, 2007). Initially, SVTs were used primarily in medicolegal set-tings, as base rates of malingering are particularly high in these settings (Larrabee, 2003). Additionally, in these setting, it is crucial that the validity of the neuropsychologi-cal test results be empirically determined, as the test results often help determine severity of cognitive impairments, which could have a large impact on whether patients receive substantial external incentives. More recently, clinicians and professional organizations have urged the use of SVTs in nonforensically based evaluations as well (America