National Academies Press: OpenBook
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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Psychological Testing
in the Service of
Disability Determination

Committee on Psychological Testing, Including Validity Testing,
for Social Security Administration Disability Determinations

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
         OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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THE NATIONAL ACADEMIES PRESS     500 Fifth Street,     NW Washington, DC 20001

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Task Order No. SS00-13-60048/0003 between the National Academy of Sciences and the U.S. Social Security Administration. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

International Standard Book Number-13: 978-0-309-37090-5
International Standard Book Number-10: 0-309-37090-6

Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.

Copyright 2015 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Suggested citation: IOM (Institute of Medicine). 2015. Psychological testing in the service of disability determination. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
×

Knowing is not enough; we must apply.
Willing is not enough; we must do.
”      

                                                —Goethe

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INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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COMMITTEE ON PSYCHOLOGICAL TESTING, INCLUDING VALIDITY TESTING, FOR SOCIAL SECURITY ADMINISTRATION DISABILITY DETERMINATIONS

HERBERT PARDES (Chair), Executive Vice Chairman of the Board, New York-Presbyterian Hospital, New York, New York

ARTHUR J. BARSKY III, Professor of Psychiatry, Harvard Medical School, and Vice Chair for Psychiatric Research, Brigham and Women’s Hospital, Boston, Massachusetts

MARY C. DALY, Senior Vice President and Associate Director of Economic Research, Federal Reserve Bank of San Francisco, California

KURT F. GEISINGER, W. C. Meierhenry Distinguished University Professor of Educational Psychology and Director, Buros Center for Testing, University of Nebraska–Lincoln

NAOMI LYNN GERBER, University Professor, Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia

ALAN M. JETTE, Professor of Health Policy & Management, Boston University School of Public Health

JENNIFER I. KOOP, Associate Professor, Department of Neurology, Medical College of Wisconsin, Milwaukee

LISA A. SUZUKI, Associate Professor of Applied Psychology, New York University Steinhardt School of Culture, Education, and Human Development, New York, New York

ELIZABETH W. TWAMLEY, Associate Professor of Psychiatry, University of California, San Diego

PETER A. UBEL, Madge and Dennis T. McLawhorn University Professor of Business, Fuqua School of Business, and Professor of Public Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina

JACQUELINE REMONDET WALL, Professor, School of Psychological Sciences, University of Indianapolis, Indiana, and Director, Office of Program Consultation and Accreditation, American Psychological Association, Washington, DC

Liaison to IOM Standing Committee of Medical Experts to Assist Social Security on Disability Issues

HOWARD H. GOLDMAN, Professor Psychiatry, University of Maryland School of Medicine, Baltimore

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
×

IOM Project Staff

CAROL MASON SPICER, Study Director

FRANK R. VALLIERE, Associate Program Officer

ALEJANDRA MARTÍN, Research Associate (since January 2015)

NICOLE GORMLEY, Senior Program Assistant (since December 2014)

JONATHAN PHILLIPS, Senior Program Assistant (April to November 2014)

JON SANDERS, Program Coordinator (through January 2015)

PAMELA RAMEY-McCRAY, Administrative Assistant

FREDERICK ERDTMANN, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

David Autor, Massachusetts Institute of Technology Economics

Leighton Chan, National Institutes of Health

Allen W. Heinemann, Northwestern University

Anita Hubley, University of British Columbia, Vancouver Campus

Michael Kirkwood, Children’s Hospital Colorado-Aurora

Glenn J. Larrabee, Clinical Neuropsychology

Brian Levitt, Kaplan Psychologists

Patricia Owens, Health and Disability Policy Programs

Stephen M. Raffle, Forensic and Clinical Psychiatry

Jerry Sweet, University of Chicago, Pritzker School of Medicine

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Nancy Adler, University of California, San Francisco, and Randy Gallistel, Rutgers University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
×

Preface

The U.S. Social Security Administration (SSA) disability programs provide important, sometimes vital, benefits to millions of adults and children annually in the United States. The programs are an expression of the nation’s principle of caring for individuals who need support from the larger community. Within the confines of SSA policy, the state Disability Determination Services (DDS) agencies, which implement the policy, have the latitude to do so in whatever way they deem fit. It is not surprising that in a country as diverse as the United States we would find geographic variations in the style and methods with which that process is undertaken.

One element of such variation is the use or not of standardized psychological tests during the disability determination process, other than the use of intelligence tests in determinations of intellectual disability in children and adults. SSA asked the Institute of Medicine (IOM) to review selected psychological tests and to provide guidance on the use of psychological testing in SSA disability determinations.

SSA and the DDS agencies have the critical task of determining which applicants qualify for disability benefits, a task complicated by the lack of direct correlation between the presence of an impairment and disability, which SSA defines as the inability to work. DDS examiners undertake the very complex task of reviewing and developing applicants’ files to determine which requests for disability benefits are justified. As described in the report, the committee felt that it was worth considering whether increased systematic use of standardized psychological testing in specific circumstances would strengthen the current process for disability determination.

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
×

The committee thanks colleagues, organizations, and agencies that were willing to share their expertise, time, and information during the committee’s information-gathering meetings. The names of the speakers are included in the meeting agendas provided in Appendix A. The committee is grateful to the authors of the two commissioned papers, Erin Bigler, David Freedman, and Jennifer Manly, for the in-depth analyses they provided. The study sponsor, SSA, gladly provided information and data and responded to questions. We also thank Howard Goldman, chair of the IOM Standing Committee of Medical Experts to Assist Social Security on Disability Issues, who served as a consultant to the committee and provided valuable insight. The contributions from all of these sources informed the committee deliberations and enhanced the quality of this report.

I want also to pay tribute to and thank the expert members of our committee. A diversity of views, at times a difference of views, all contributed to generating a consensus about issues important to SSA and to the country. Throughout the project, they put in an enormous amount of time and effort; contributed their experience, knowledge, and perspective; listened to contending arguments; and ultimately generated the recommendations in this report. It is heartening to me and the other committee members to experience the excellence and the commitment of so many good colleagues. I trust this report will be helpful to and well received by SSA.

Finally, the committee thanks the IOM staff members who contributed to the production of this report, including Frederick “Rick” Erdtmann (board director), Carol Mason Spicer (study director), Frank Valliere (associate program officer), Alejandra Martín (research associate), Nicole Gormley (senior program assistant), Jonathan Phillips (senior program assistant), Jon Sanders (program coordinator), Julie Wiltshire (financial associate), and other staff of the Board on the Health of Select Populations and the IOM, who provided support. Research assistance was provided by Daniel Bearss, Rebecca Morgan, and Catherine van der List.

Herbert Pardes, Chair
Committee on Psychological Testing, Including
Validity Testing, for Social Security Administration
Disability Determinations

Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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Acronyms and Abbreviations

AACN American Academy of Clinical Neuropsychology
AADEP American Academy of Disability Evaluating Physicians
ABCN American Board of Clinical Neuropsychology
ABIME American Boards of Independent Medical Examiners
ADL activity of daily living
AFB Ability-Focused Neuropsychological Test Battery
ALJ administrative law judge
AMA American Medical Association
APA American Psychological Association
ASAPIL Association for Scientific Advancement in Psychological
  Injury and Law
 
BDI Beck Depression Inventory
BLS Bureau of Labor Statistics
BPRS Brief Psychiatric Rating Scale
BSI Brief Symptom Inventory
BVMT-R Brief Visuospatial Memory Test-Revised
 
C&P compensation and pension
CASL Comprehensive Assessment of Spoken Language
CBCL Child Behavior Checklist
CDMI Composite Disability Malingering Index
CE consultative examination
CELF-4 Clinical Evaluation of Language Fundamentals-4
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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CFS chronic fatigue syndrome
CIDI Composite International Diagnostic Interview
CPP Canada Pension Plan
CRPS complex regional pain syndrome
CVLT-II California Verbal Learning Test—second edition
 
DDS Disability Determination Services
DIF differential item functioning
DOM Depression Outcomes Module
DSM Diagnostic and Statistical Manual of the American
  Psychiatric Association
 
GAF Global Assessment of Functioning Scale
GAO Government Accountability Office
 
HVLT-R Hopkins Verbal Learning Test-Revised
 
ICF International Classification of Functioning, Disability and Health
ID intellectual disability
IDES Integrated Disability Examination System
IME independent medical examination
IOM Institute of Medicine
IQ intelligence quotient
IRT item response theory
 
MDI medically determinable impairment
MEDCOM U.S. Army Medical Command
M-FAST Miller Forensic Assessment of Symptom Test
MINI Mini International Neuropsychiatric Interview
MMPI Minnesota Multiphasic Personality Inventory
MMY Mental Measurements Yearbook
MRFC Mental Residual Functional Capacity
MSVT Medical Symptom Validity Test
 
NAN National Academy of Neuropsychology
NIH National Institutes of Health
NIM Negative Impressionism
NPP negative predictive power
NPRM Notice of Proposed Rulemaking
NRC National Research Council
 
Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2015. Psychological Testing in the Service of Disability Determination. Washington, DC: The National Academies Press. doi: 10.17226/21704.
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OIDAP Occupational Information Development Advisory Panel
OIS Occupational Information System
OTSG Office of the Surgeon General
 
P-3 Pain Patient Profile
PAI Personality Assessment Inventory
PCE psychological consultative examination
PDRT Portland Digit Recognition Test
PHQ Patient Health Questionnaire
POMS Program Operations Manual System
PPP positive predictive power
PTSD posttraumatic stress disorder
PVT performance validity test
 
RAVL Rey Auditory Verbal Learning
RDS Reliable Digit Span
RMFIT Rey Memory for Fifteen Items Test
RMT Recognition Memory Test
RMTF Warrington Recognition Memory Test for Faces
 
SCAN Schedule for Clinical Assessment in Neuropsychiatry
SCL-90-R Symptom Checklist 90-Revised
SDM single-decision-maker
SGA substantial gainful activity
SIMS Structured Inventory of Malingered Symptomology
SIRS Structured Interview of Reported Symptoms
SSA U.S. Social Security Administration
SSDI Social Security Disability Insurance
SSI Supplemental Security Income
SVT symptom validity test
 
TBI traumatic brain injury
TMJ temporomandibular joint disorder
TOMM Test of Memory Malingering
 
VA U.S. Department of Veterans Affairs
VBA Veterans Benefits Administration
VHA Veterans Health Administration
 
WAIS Wechsler Adult Intelligence Scale
WHO World Health Organization
WISC Wechsler Intelligence Scale for Children
WMS Wechsler Memory Scale
WMT Word Memory Test
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The United States Social Security Administration (SSA) administers two disability programs: Social Security Disability Insurance (SSDI), for disabled individuals, and their dependent family members, who have worked and contributed to the Social Security trust funds, and Supplemental Security Income (SSSI), which is a means-tested program based on income and financial assets for adults aged 65 years or older and disabled adults and children. Both programs require that claimants have a disability and meet specific medical criteria in order to qualify for benefits. SSA establishes the presence of a medically-determined impairment in individuals with mental disorders other than intellectual disability through the use of standard diagnostic criteria, which include symptoms and signs. These impairments are established largely on reports of signs and symptoms of impairment and functional limitation.

Psychological Testing in the Service of Disability Determination considers the use of psychological tests in evaluating disability claims submitted to the SSA. This report critically reviews selected psychological tests, including symptom validity tests, that could contribute to SSA disability determinations. The report discusses the possible uses of such tests and their contribution to disability determinations. Psychological Testing in the Service of Disability Determination discusses testing norms, qualifications for administration of tests, administration of tests, and reporting results. The recommendations of this report will help SSA improve the consistency and accuracy of disability determination in certain cases.

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