Dissimulation strategies on neuropsychological tests: A qualitative investigation

People are known to feign or exaggerate symptoms of cognitive impairment for a wide range of reasons, such as for financial gain or avoidance of criminal responsibility. With £5.2 million paid out daily in compensation claims (Association of British Insurers, 2011), it is important that neuropsychologists have as much information as possible at their disposal for detecting unworthy claims. This study investigates the strategies employed by individuals attempting to feign cognitive impairment on standard neuropsychological tests. A review of the literature revealed that most previous studies in the area of malingering neuropsychological deficits have focused on developing and validating measures to detect falsification of symptoms or poor performance on standard tests. The only qualitative study published in this area investigated strategies employed by individuals feigning memory impairment (Iverson, 1995). Iverson (1995) used questionnaires and brief interviews, subjected to a simple content analysis. The present research constitutes a more thorough and in-depth qualitative study than any that have been previously disseminated in this area. Detailed semi-structured interviews were administered to 15 non-neurological individuals instructed to feign cognitive impairment on a battery of standard neuropsychological tests. The interviews examined both the strategies used and the thinking underlying participants’ choices to achieve a richer and more detailed understanding of the phenomena of feigning. Thematic Analysis revealed three main organising themes. Participants described Using Strategies, on specific tests and generally across the battery, offered explanations of the Rationale behind their decisions and spontaneously commented on their Experience of the Task. The findings of the present study reveal numerous potentially useful identifiers of feigning strategies, including many not previously reported. The resulting themes point to the development of more effective methods for detecting feigned cognitive impairments and could have a significant impact on the way that neuropsychological testing sessions are conducted