Determination of effort level, exaggeration, and malingering in neurocognitive assessment

This article presents a review of the field of effort level determination in TBI assessment as well as how to determine which effort level measure is most appropriate for common assessment situations. The importance of effort level assessment in forensic settings, and also in assessments conducted in both diagnostic and rehabilitation programs, which rely on test performances to develop treatment plans or to measure progress and outcome, is discussed.

Historical review and summaries of specific measures designed to characterize effort level in assessment of persons suffering TBI.

There are several effort level measures that have withstood the scrutiny of cross-validation research. These include the Computerized Assessment of Response Bias (CARB), Portland Digit Recognition Test (PDRT), Test of Memory Malingering (TOMM), Validity Indicator Profile (VIP), Victoria Symptom Validity Test (VSVT), and Word Memory Test (WMT).

Depending on the neurocognitive test performances(s) evidencing suboptimal effort or complaints that may be questionable, it is recommended that at least 2 of the above-listed measures be employed for proper assessment of effort level.