The need for continuous and comprehensive sampling of effort/response bias during neuropsychological examinations

While most neuropsychologists are now administering measures of response bias in neuropsychological evaluations, it is still likely that detection of non-credible test performance is inadequate due to faulty assumptions regarding poor effort, namely that it remains constant across a battery of tests. Four cases are described that illustrate the variability in negative response bias that occurs during neuropsychological evaluations; if effort had not been periodically sampled with heterogeneous types of effort indicators during these examinations, the suspect performance would not have been detected. These examples argue for both continuous and comprehensive sampling of effort, specifically that negative response bias be routinely monitored throughout neuropsychological evaluations, and that effort indicators involving differing cognitive abilities be employed to assess for feigning of selective deficits.