Psychological Testing in the Service of Disability Determination (2015) / Chapter Skim
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4 Self-Report Measures and Symptom Validity Tests
4 Self-Report Measures and Symptom Validity Tests
Pages 117-140
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From page 117... ...
must be established by medical evidence consisting of signs, symptoms, and laboratory findings -- not only by the individual's statement of symptoms. Following establishment of a medically determinable impairment, the overall degree of functional limitation is evaluated based on the extent to which the applicant's impairment interferes with his or her "ability to 117
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From page 118... ...
The current chapter focuses on the potential role of non-cognitive psychological measures, often characterized as self-report measures, in SSA disability determinations. It begins with an examination of potential domains for which psychological self-report measures may provide information to assist in identifying a claimant's medically determinable impairment and determining the level of functional limitation.
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From page 119... ...
. According to SSA regulations, such instruments may be considered medically acceptable laboratory diagnostic techniques, and thus provide signs and laboratory findings that corroborate the claimant's self-report of symptoms.
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FIGURE 4-1 Psychological versus nonpsychological self-report measures. NOTE: BDI = Beck Depression Inventory; BPI = Brief Pain Inventory; FSS = Fatigue Severity Scale; MAF = Multidimensional Assessment of Fatigue; MCMI = Millon Clinical Multiaxial Inventory; MMPI = Minnesota Multiphasic Personality Inventory; MMPQ = McGill-Melzack PainFigure 4-1 PAI = Personality Assessment Questionnaire; Inventory; PSQI = Pittsburgh Sleep Quality Index; SADS = Schedule for Affective Disorders and Schizophrenia; SCID = Structured Clinical Interview for DSM Disorders; SCL-90R = Symptom Checklist 90 Revised; Vineland-II = Vineland Adaptive Behavior Scales.
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From page 121... ...
In addition, conduct disorder and oppositional defiant disorder are contained in the SSA listing for personality disorders. 2 Although somatoform disorders are included in the SSA mental health listings, the com mittee focuses on these in the next section on disproportionate somatic symptoms, alongside multisystem illnesses and chronic idiopathic pain conditions.
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SOURCE: SSA, n.d.-a. Similar to those listed for adults, mental disorders present in childhood are well-established conditions listed in the DSM-5 (American Psychiatric Association, 2013)
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disorders are diagnosable psychiatric disorders with distinct, well-elaborated diagnostic criteria (American Psychiatric Association, 2013) ; as such, they are among the listed mental disorders that are eligible for SSA disability compensation.
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Confirming the Existence of a Disability As noted above, a disability determination requires a medically determinable impairment that affects an applicant's ability to function in a work setting. Such a determination must be confirmed with observable signs and laboratory findings.
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Broad personality and multiscale inventories can provide medical evidence of a wide variety of mental disorders. The most prominent example of such measures is the Minnesota Multiphasic Personality Inventory (MMPI)
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, which comprises three clinical scales measuring depression, anxiety, and somatization. The second criterion in disability determinations is the impact of the medically determinable impairment on the applicant's ability to function in a work setting, what SSA refers to as the Paragraph B criteria.
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4 for its mental disorders listings, which among other changes, would alter the functional categories on which disability determinations would be based, increasing focus on the relation of functioning to the work setting. Proposed functional domains in the NPRM are the abilities to (1)
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Normative data are typically gathered on generally healthy individuals who are free from significant mental impairments. Data are generally gathered on samples that reflect the broad demographic characteristics of the United States including factors such as age, gender, and educational status.
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Additionally, consideration of the examinee's language and administration of a test that has been translated and normed within the language is generally recommended. SSA requires psychological testing be "individually administered by a qualified specialist," defining qualified as "currently licensed or certified in the state to administer, score, and interpret psychological tests and have the training and experience to perform the test" (SSA, n.d.-a)
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, or a formal analysis of internal data consistency. Symptomatic complaint may also be considered against typical diagnostic considerations, such as onset, symptom presentation, course, and response to treatment (Heilbronner et al., 2009)
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SVTs assess negative self-presentation in a variety of ways. Often, test-takers are presented with questions about infrequent or unlikely behaviors or symptoms; SVTs look for patterns of overreporting or amplification on these items, as compared to some population (e.g., general, psychiatric for mental complaints, medical patients for somatic complaints)
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From page 132... ...
Symptom Validity and the Disability Determination Process When an applicant's medical record is based primarily on self-report, assessment of symptom validity helps the evaluator assess the accuracy of an individual's self-report of behavior, experiences, or symptoms. For this reason, it is important to include an assessment of symptom validity in the medical evidence of record.
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found in persons simulating mental disorders than in clinical patients Rogers Discriminant A statistically determined method that distinguishes Function (RDF) simulators from those who were responding honestly a Ben-Porath et al., 2008.
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• Affective Disorders (AF) The 25-item Miller Forensic Assessment of Symptoms Test (M-FAST)
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. All three organizations recommend that other factors, such as culture, language, and functional limitations, also be considered when assessing validity.
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unaccompanied by cognitive complaints or a disorder with somatic symptoms that are disproportionate to demonstrable medical morbidity (i.e., somato form disorders, multisystem illnesses, and chronic idiopathic pain conditions)
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2013. The diagnostic and statistical manual of mental disorders: DSM-5.
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Presentation to IOM Committee on Psychological Testing, Including Validity Testing, for Social Security Administration, June 25, 2014, Washington, DC. Miller, H
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Lutz, FL: Psychological Assessment Resources.
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