Psychological Testing in the Service of Disability Determination (2015) / Chapter Skim
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5 Cognitive Tests and Performance Validity Tests
5 Cognitive Tests and Performance Validity Tests
Pages 141-176
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These skills and abilities cannot be evaluated in any detail without formal standardized psychometric assessment. This chapter examines cognitive testing, which relies on measures of task performance to assess cognitive functioning and establish the severity of cognitive impairments.
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As will be discussed below, cognitive testing may prove beneficial to the assessment of each of these requirements. ADMINISTRATION OF COGNITIVE AND NEUROPSYCHOLOGICAL TESTS TO EVALUATE COGNITIVE IMPAIRMENT In contrast to testing that relies on self-report, as outlined in the preceding chapter, evaluating cognitive functioning relies on measures of task performance to establish the severity of cognitive impairments.
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. In the context of the SSA disability determination process, cognitive testing for claimants alleging cognitive impairments could be helpful in establishing a medically determinable impairment, functional limitations, and/or residual functional capacity.
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Cognitive testing is valuable in both child and adult assessments in determining the existence of a medically determinable impairment and evaluating associated functional impairments and residual functional capacity. Cognitive impairments may be the result of intrinsic factors (e.g., neurodevelopmental disorders, genetic factors)
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committee has adopted these six domains of cognitive functioning for its examination of cognitive testing in disability determinations. Each of these functional domains would also be relevant areas of assessment in children applying for disability support.
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For a more comprehensive list and review of cognitive tests, readers are referred to the comprehensive textbooks, Neuropsychological Assessment (Lezak et al., 2012) or A Compendium of Neuropsychological Tests (Strauss et al., 2006)
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. However, it is important to note that semantic, autobiographical, and implicit memory are generally preserved in all but the most severe forms of neurocognitive dysfunction (American Psychiatric Association, 2013; OIDAP, 2009)
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, Brief Visuospatial Memory Test-Revised (Benedict, 1997) , and the Rey-Osterrieth Complex Figure Test (Rey, 1941)
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Selection of appropriate measures and assessment of applicability of normative data vary depending on the purpose of the evaluation. Cognitive tests can be used to identify acquired or developmental cognitive impairment, to determine the level of functioning of an individual relative to typically functioning same-aged peers, or to assess an individual's functional capacity for everyday tasks (Freedman and Manly, 2015)
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. In this situation, use of otherwise appropriate standardized and psychometrically sound performance-based or cognitive tests is appropriate.
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. Interindividual Differences The most basic level of interpretation is simply to compare an individual's testing results with the normative data collected in the development of the measures administered.
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. Interpreting Poor Cognitive Test Performance Regardless of the level of interpretation, it is important for any evaluator to keep in mind that poor performance on a set of cognitive or neuropsychological measures does not always mean that an individual is truly impaired in that area of functioning.
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The evaluator must consider the validity and reliability of the data acquired, such as whether or not there were errors in administration that rendered the data invalid, emotional or psychiatric factors that affected the individual's performance, or sufficient effort put forth by the individual on all measures. To answer the latter question, administration of performance validity tests (PVTs)
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documentation regarding evaluation of intellectual disability, the specialist completing psychological testing "must be currently licensed or certified in the state to administer, score, and interpret psychological tests and have the training and experience to perform the test." However, as mentioned above, the training received by most clinical psychologists is limited to certain domains of functioning, including measures of general intellectual functioning, academic achievement, aptitude, and psychological/emotional functioning. Again, if the request for disability is based on a claim of intellectual disability or significant emotional/behavioral dysfunction, a psychologist with solid psychometric training from any of these programs should be capable of providing appropriate interpretation of the testing
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If a test-taker is not able to give his or her best effort, for whatever reason, the test results cannot be interpreted as accurately reflecting the test-taker's ability level. As discussed in detail in Chapter 2, a number of studies have examined potential for malingering when there is a financial incentive for appearing impaired, suggesting anywhere from 19 to 68 percent of SSA disability applicants may be performing below their capability on cognitive tests or inaccurately reporting their symptoms (Chafetz, 2008; Chafetz et al., 2007; Griffin et al., 1996; Mittenberg et al., 2002)
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, with much of the initial focus on examining the consistency of an individual's responses across a battery of testing, with the suggestion that inconsistency may indicate variable effort. However, a significant push for specific formal measures came in response to the increased use of neuropsychological and cognitive testing in forensic contexts, including personal injury litigation, workers compensation, and criminal proceedings in the 1980s and 1990s (Bianchini et al., 2001; Larrabee, 2012a)
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Performances below these cutoff points are interpreted as demonstrating invalid test performance. Types of PVTs PVTs may be designed as such and embedded within other cognitive tests, later derived from standard cognitive tests, or designed as stand-alone measures.
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As with many stand-alone measures, the TOMM, WMT, and RMFIT are memory tests that appear more difficult than they really are. The TOMM and WMT use a forced-choice method to identify noncredible performance in which the test-taker is asked to identify which of two stimuli was previously presented.
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AVLT RMT Rey Auditory Verbal Learning Test Binder, Villanueva, Howieson, Recognition Memory Test and Moore (1993) b-test b-test Boone, Lu, and Herzberg (2002[b]
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Administration and Interpretation of PVTs It is within that historical medicolegal context that clinical practice guidelines for neuropsychology emerged to emphasize the use of psychometric indicators of response validity (as opposed to clinician judgment alone) in determining the interpretability of a battery of cognitive tests
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This consideration is particularly important in evaluations in which the test-taker's performance on cognitive measures falls below an expected level, suggesting potential cognitive impairment. That is, an individual's poor performance on cognitive measures may reflect insufficient effort to perform well, as suggested by PVT performance, rather than a true impairment.
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. The practice standards require clinical neuropsychologists performing evaluations of cognitive functioning for diagnostic purposes to include PVTs and comment on the validity of test findings in their reports.
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However, the need for this type of normative data is minimal given the fact that the simple nature of tasks allows most patients with even severe brain injury, let alone "typical" individuals, to perform at near perfect levels (Larrabee, 2014a)
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. Although many would argue that PVT failure caused by true cognitive impairment is rare, the fact that failure could occur for valid reasons means that interpretation of PVT performances is exceptionally critical and must be done very cautiously.
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in certain populations reflect legitimate cognitive impairments. For this reason, it has also been recommended that close attention be paid to the pattern of PVT performance and the potential for false positives in these at-risk populations in order to inform interpretation and reduce the chances for false positives (Larrabee, 2014a,b)
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. APPLICANT POPULATIONS FOR WHOM PERFORMANCE BASED TESTS SHOULD BE CONSIDERED OR USED As suggested above, there are many applicants for whom administration of cognitive or neuropsychological testing would be beneficial to improve the standardization and credibility of determinations based on allegations of disability on the basis of cognitive impairment.
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For all of these claimants, documentation of impairment in functional cognitive domains with standardized cognitive tests is critically important. Within the
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CONCLUSION The results of standardized cognitive tests that are appropriately administered, interpreted, and validated can provide objective evidence to help identify and document the presence and severity of medically determinable mental impairments at Step 2 of SSA's disability determination process. In addition, such tests can provide objective evidence to help identify and assess the severity of work-related cognitive functional impairment relevant to disability evaluations at the listing level (Step 3)
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Presentation to IOM Committee on Psychological Testing, Including Validity Testing, for Social Security Administration, June 25, 2014, Washington, DC.
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Paper commissioned by the IOM Committee on Psychological Testing, Including Validity Testing, for Social Security Administration Disability Determinations. http://www.iom.edu/psychtestingpaperEB (accessed April 9, 2015)
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Paper commissioned by the IOM Committee on Psychological Testing, Including Validity Testing, for Social Security Administration Disability Determinations. http://www.iom.edu/psychtestingpapersDFJM (accessed April 9, 2015)
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2013. Symptom validity testing in medically unexplained pain: A chronic regional pain syndrome type 1 case series.
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Presentation to IOM Committee on Psychological Testing, Including Validity Testing, for Social Security Administration, June 25, 2014, Washington, DC. Kirkwood, M
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Presentation to IOM Committee on Psychological Testing, Including Validity Testing, for Social Security Administration, June 25, 2014, Washington, DC. Lewis, R
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2008. Frequency and bases of abnormal performance by healthy adults on neuropsychological testing.
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2009. Interpreting the meaning of multiple symptom validity test failure.
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