The value of embedded measures in detecting suboptimal effort in children: an investigation into the WISC-IV Digit Span and CMS Verbal Memory subtests

The Test of Memory Malingering (TOMM) is a measure of test-taking effort that has traditionally been utilized with adults but more recently has demonstrated utility with children. The purpose of this study was to investigate whether commonly used neuropsychological measures can be used as embedded measures in detecting effort during testing. Participants (N = 75) who completed neuropsychological evaluations including the TOMM, Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) Digit Span, Children's Memory Scale (CMS) Verbal Memory, and other neuropsychological measures were divided into two groups: Optimal Effort and Suboptimal Effort, based on their TOMM Trial 2 scores. Digit Span findings suggest a useful standard score of ≤ 70 resulted in optimal cutoff scores, yielding specificity of 94% and sensitivity of 44%. The CMS Verbal Memory Recall > Recognition scores did not appear as valuable indicating a discrepancy of 20+ points were required for specificity to attain optimal scores of 90% and sensitivity of 11%. This study illustrates the WISC-IV may have good utility in determining optimal effort; however, the CMS may not be as functional.