Development and initial validation of a structured interview for the detection of malingered mild head injury

Neuropsychologists often assess individuals involved in litigation, and who may be in a position to obtain significant financial compensation. Malingering measures are often employed in these assessments, however, the accuracy of these measures may be less than satisfactory. Most malingering measures are not targeted to mild head injury, a very common type of claim. The goal of this research was to begin the development and validation of a measure specifically designed to detect malingering of mild head injury symptoms. More accurate assessment can help identify false claims, and also establish the merit of genuine claims. A 472-item questionnaire was developed by three writers based on knowledge of head injury sequelae and malingering detection techniques. This questionnaire contained both common, plausible symptoms following injury, and implausible symptoms. Malingering individuals may not only overendorse true symptoms, but may identify implausible symptoms or deny positive attributes in an attempt to appear impaired. The ability of this questionnaire to discriminate between individuals answering honestly and individuals faking mild brain injury was evaluated in a classic simulation study with a university sample. Participants ( N = 330) were instructed to either respond honestly to the items (honest responders) or to respond as if they had sustained a mild brain injury and were attempting to demonstrate deficits in order to receive financial compensation (malingering responders). Malingering responders scored significantly and substantially higher than the honest responders on the questionnaire. Cutoff scores accurately classified approximately 95% of participants, with high rates of sensitivity and specificity. Results of cross-validation analyses indicated that total scores on the questionnaire may have good cross-situational consistency. And, an analysis of within-subject response consistency over a relatively short period of time suggested that individuals answering honestly produced more consistent responses over time than malingering responders. Overall, this measure shows promise in discriminating honest responders from those feigning mild brain injuries. Future research will focus primarily on the questionnaire\u27s ability to distinguish individuals with true head injury sequelae from other populations, such as those involved in litigation and individuals with disorders similar in symptom presentation to mild head injury (e.g., toxin exposure and depression)