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Related Experiment Videos

Detecting exaggeration and malingering with the trail making test.

Grant L Iverson1, Rael T Lange, Paul Green

  • 1Department of Psychiatry, University of British Columbia & Riverview Hospital, Vancover, BC, Canada. giverson@interchange.ubc.ca

The Clinical Neuropsychologist
|February 28, 2003
PubMed
Summary
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The Trail Making Test (TMT) can flag potential exaggeration in mild traumatic brain injuries, but its low sensitivity means it often misses cases of deliberate poor performance.

Area of Science:

  • Neuropsychology
  • Forensic Psychology
  • Traumatic Brain Injury (TBI) Assessment

Background:

  • Distinguishing genuine cognitive impairment from malingering is crucial in TBI evaluations.
  • The Trail Making Test (TMT) is frequently used to assess cognitive function following head injuries.
  • Previous research suggests TMT performance may be sensitive to deliberate exaggeration.

Purpose of the Study:

  • To investigate if unusual TMT performance indicates intentional exaggeration in patients with acute traumatic brain injuries.
  • To develop cutoff scores for TMT to identify potential response bias.
  • To compare the TMT performance of head injury litigants with known exaggeration to established cutoffs.

Main Methods:

  • Study included 571 patients with acute traumatic brain injuries (TBIs) and 228 head injury litigants.

Related Experiment Videos

  • TMT A and TMT B performance was analyzed in relation to TBI severity.
  • Cutoff scores at the 5th percentile were established for TBI patients.
  • The performances of litigants with confirmed exaggeration on other tests were compared to these TMT cutoffs.

    • Main Results:

    • Higher TBI severity correlated with poorer TMT performance.
    • Positive predictive values for exaggeration were high (100%) for very mild TBIs but lower (55.6-60%) for more severe TBIs.
    • Negative predictive values were moderate (66.4-78.2%), and sensitivity for detecting exaggeration was very low (7.1-18.5%) across all groups.

    Conclusions:

    • While TMT scores below the 5th percentile may serve as 'red flags' for potential response bias, they lack psychometric or biological sense.
    • The TMT's low sensitivity makes it unreliable as a sole measure for detecting deliberate poor performance in TBI cases.
    • Clinicians should avoid relying exclusively on the TMT to identify malingering, as the majority of such cases will be missed.